Provider Demographics
NPI:1912002577
Name:CRAIGHEAD, WADE EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:EDWARD
Last Name:CRAIGHEAD
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 1:8321 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4713
Mailing Address - Country:US
Mailing Address - Phone:303-875-1752
Mailing Address - Fax:303-492-2967
Practice Address - Street 1:RAIMY CLINIC
Practice Address - Street 2:D244 MUENZINGER BUILDING
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0001
Practice Address - Country:US
Practice Address - Phone:303-875-1752
Practice Address - Fax:303-492-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical