Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4252 | OH |
N | 103TC0700X | Clinical Psychologist | 4252 | OH |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4252 | OH |
NPI | 1134491095 |
---|---|
Provider Name | Dr. Shari L. Wade |
First Address | Oxford, OH 45056-8793 |
Second Address | Oxford, OH 45056-8793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2012 |
Last Update Date | 07/02/2012 |