Provider Demographics
NPI:1184291882
Name:WADE, KERRY A (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:A
Last Name:WADE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:WILTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 PAPIT GUIDRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-6211
Mailing Address - Country:US
Mailing Address - Phone:337-280-2066
Mailing Address - Fax:
Practice Address - Street 1:1034 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARKS
Practice Address - State:LA
Practice Address - Zip Code:70582-6639
Practice Address - Country:US
Practice Address - Phone:337-909-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist