Provider Demographics
NPI:1508896937
Name:WADE, POLLY BYRNE (MA)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:BYRNE
Last Name:WADE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA OUTPATIENT CLINIC - AUDIOLOGY (126)
Mailing Address - Street 2:150 MUIR ROAD
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:925-372-2050
Mailing Address - Fax:925-370-4031
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:AUDIOLOGY (126)/ VA OUTPATIENT CLINIC
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2050
Practice Address - Fax:925-370-4031
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 926231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist