Provider Demographics
NPI:1316387921
Name:WADE, EMILIE B
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:B
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:B
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2615 N PRICKETT RD STE 10
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7546
Mailing Address - Country:US
Mailing Address - Phone:501-847-7337
Mailing Address - Fax:
Practice Address - Street 1:2615 N PRICKETT RD STE 10
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7546
Practice Address - Country:US
Practice Address - Phone:501-847-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist