Provider Demographics
NPI:1063504736
Name:WADE, JOHN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WADE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF KANSAS
Mailing Address - Street 2:COUNSELING AND PSYCH SERVICES, 1200 SCHWEGLER DRIVE
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7559
Mailing Address - Country:US
Mailing Address - Phone:785-864-2277
Mailing Address - Fax:785-864-2721
Practice Address - Street 1:UNIVERSITY OF KANSAS
Practice Address - Street 2:COUNSELING AND PSYCH SERVICES, 1200 SCHWEGLER DRIVE
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7559
Practice Address - Country:US
Practice Address - Phone:785-864-2277
Practice Address - Fax:785-864-2721
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1043103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling