Provider Demographics
NPI:1396957882
Name:WADE, ERIN J (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:J
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:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:SUBLETTE
Mailing Address - State:IL
Mailing Address - Zip Code:61367-0229
Mailing Address - Country:US
Mailing Address - Phone:815-627-0641
Mailing Address - Fax:
Practice Address - Street 1:1437 S BELL SCHOOL RD STE 7
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1405
Practice Address - Country:US
Practice Address - Phone:815-627-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007297103TM1800X
KY269565103K00000X
WI282-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst