Provider Demographics
NPI:1417620121
Name:KIDNER, WADE LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:LEE
Last Name:KIDNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-8461
Mailing Address - Country:US
Mailing Address - Phone:816-433-8581
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-8461
Practice Address - Country:US
Practice Address - Phone:816-533-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019047061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health