Provider Demographics
NPI:1306181284
Name:WADLEY, MARION MARSHA (EDD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:MARSHA
Last Name:WADLEY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 LUPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3847
Mailing Address - Country:US
Mailing Address - Phone:408-298-9557
Mailing Address - Fax:408-292-2294
Practice Address - Street 1:1443 LUPTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3847
Practice Address - Country:US
Practice Address - Phone:408-298-9557
Practice Address - Fax:408-292-2294
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical