Provider Demographics
NPI:1114217148
Name:WADE, WENDY JO (LMFT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JO
Last Name:WADE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39267 HEMINGWAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5352
Mailing Address - Country:US
Mailing Address - Phone:952-261-5335
Mailing Address - Fax:
Practice Address - Street 1:818 GOLDEN WAY NW
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6508
Practice Address - Country:US
Practice Address - Phone:763-444-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist