Provider Demographics
NPI:1538481973
Name:IDDEEN-WADE, AYSHA Z
Entity Type:Individual
Prefix:MRS
First Name:AYSHA
Middle Name:Z
Last Name:IDDEEN-WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 N CLASSEN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5810
Mailing Address - Country:US
Mailing Address - Phone:405-528-1748
Mailing Address - Fax:405-528-1802
Practice Address - Street 1:2220 N CLASSEN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5809
Practice Address - Country:US
Practice Address - Phone:405-528-1748
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health