Provider Demographics
NPI:1275604720
Name:WADE, KATHLEEN KILEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KILEY
Last Name:WADE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:KILEY
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:15002 N 32ND ST
Mailing Address - Street 2:PARADISE VALLEY UNIFIED SCHOOL DISTRICT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4441
Mailing Address - Country:US
Mailing Address - Phone:602-449-3777
Mailing Address - Fax:
Practice Address - Street 1:15002 N 32ND ST
Practice Address - Street 2:PARADISE VALLEY UNIFIED SCHOOL DISTRICT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4441
Practice Address - Country:US
Practice Address - Phone:602-449-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3820103T00000X
CA20921103T00000X
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool