Provider Demographics
NPI:1265823462
Name:WADE-JONES, KATHLEEN RENE' (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RENE'
Last Name:WADE-JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S ROSE ST
Mailing Address - Street 2:SUITE 617
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4792
Mailing Address - Country:US
Mailing Address - Phone:269-350-5661
Mailing Address - Fax:269-350-5501
Practice Address - Street 1:151 S ROSE ST
Practice Address - Street 2:SUITE 617
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4792
Practice Address - Country:US
Practice Address - Phone:269-350-5661
Practice Address - Fax:269-350-5501
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010874381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical