Provider Demographics
NPI:1578699583
Name:WADE, ANGIE THOMAS (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:THOMAS
Last Name:WADE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9129
Mailing Address - Country:US
Mailing Address - Phone:502-222-0243
Mailing Address - Fax:502-225-4907
Practice Address - Street 1:2204 COURTNEY DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9129
Practice Address - Country:US
Practice Address - Phone:502-222-0243
Practice Address - Fax:502-225-4907
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist