Healthcare Provider Details

I. General information

NPI: 1881233260
Provider Name (Legal Business Name): JESSICA WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

IV. Provider business mailing address

8490 E CRESCENT PKWY STE 200
GREENWOOD VILLAGE CO
80111-2802
US

V. Phone/Fax

Practice location:
  • Phone: 847-306-9843
  • Fax:
Mailing address:
  • Phone: 720-441-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: