Provider Demographics
NPI:1861814428
Name:WADE, NATHANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 NORTHRIDGE PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4096
Mailing Address - Country:US
Mailing Address - Phone:515-294-1455
Mailing Address - Fax:
Practice Address - Street 1:2613 NORTHRIDGE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4096
Practice Address - Country:US
Practice Address - Phone:515-294-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01000103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy