Healthcare Provider Details

I. General information

NPI: 1063504736
Provider Name (Legal Business Name): JOHN C WADE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KANSAS COUNSELING AND PSYCH SERVICES, 1200 SCHWEGLER DRIVE
LAWRENCE KS
66045-7559
US

IV. Provider business mailing address

UNIVERSITY OF KANSAS COUNSELING AND PSYCH SERVICES, 1200 SCHWEGLER DRIVE
LAWRENCE KS
66045-7559
US

V. Phone/Fax

Practice location:
  • Phone: 785-864-2277
  • Fax: 785-864-2721
Mailing address:
  • Phone: 785-864-2277
  • Fax: 785-864-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1043
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: