Healthcare Provider Details

I. General information

NPI: 1447805155
Provider Name (Legal Business Name): MIRIAM WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 TEMPLETON DR STE 103
OSWEGO IL
60543-7015
US

IV. Provider business mailing address

70 S RIVER ST
AURORA IL
60506-5185
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax: 630-844-3084
Mailing address:
  • Phone: 630-844-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149002778
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: