Provider Demographics
NPI:1720526718
Name:WADE, KATHLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 MICHELLE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9253
Mailing Address - Country:US
Mailing Address - Phone:734-717-4186
Mailing Address - Fax:
Practice Address - Street 1:1809 MICHELLE CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9253
Practice Address - Country:US
Practice Address - Phone:734-717-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010803361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical