Provider Demographics
NPI:1225557119
Name:WADE, ASHLEY AMBER
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMBER
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W 126TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3856
Mailing Address - Country:US
Mailing Address - Phone:646-853-5897
Mailing Address - Fax:
Practice Address - Street 1:100 READE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3889
Practice Address - Country:US
Practice Address - Phone:212-920-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist