Provider Demographics
NPI:1396118709
Name:WADE, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SHERMAN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4818
Mailing Address - Country:US
Mailing Address - Phone:847-869-1500
Mailing Address - Fax:847-869-1515
Practice Address - Street 1:1560 SHERMAN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4818
Practice Address - Country:US
Practice Address - Phone:847-869-1500
Practice Address - Fax:847-869-1515
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011176101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor