Provider Demographics
NPI:1821040445
Name:WADE-MONARCO, DAVID O (LSCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:WADE-MONARCO
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2623
Mailing Address - Country:US
Mailing Address - Phone:620-371-6548
Mailing Address - Fax:620-371-7119
Practice Address - Street 1:2006 1ST AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2623
Practice Address - Country:US
Practice Address - Phone:620-371-6548
Practice Address - Fax:620-371-7119
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 39151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200460320CMedicaid
KSKA3498001Medicare PIN