Provider Demographics
NPI:1740458132
Name:WADLE AND ASSOCITES, P.C
Entity type:Organization
Organization Name:WADLE AND ASSOCITES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCBROOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:515-270-1344
Mailing Address - Street 1:2327 70TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4825
Mailing Address - Country:US
Mailing Address - Phone:515-270-1344
Mailing Address - Fax:515-270-6515
Practice Address - Street 1:2327 70TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-4825
Practice Address - Country:US
Practice Address - Phone:515-270-1344
Practice Address - Fax:515-270-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty