Provider Demographics
NPI:1346320371
Name:WADE WALSH, MARGO (PHD)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:WADE WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 FORD DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6482
Mailing Address - Country:US
Mailing Address - Phone:253-265-1448
Mailing Address - Fax:253-265-1448
Practice Address - Street 1:7106 FORD DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6482
Practice Address - Country:US
Practice Address - Phone:253-265-1448
Practice Address - Fax:253-265-1448
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8405326Medicaid
WAAB36789OtherMEDICARE ID
WAAB36789OtherMEDICARE ID