Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1043 | KS |
NPI | 1063504736 |
---|---|
Provider Name | Dr. John C Wade |
First Address | Lawrence, KS 66045-7559 |
Second Address | Lawrence, KS 66045-7559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |