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General NPI Number Information
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NPI Number | 1447757844
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Entity Type | Individual
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Provider Name | WADE HAACK
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Gender | Male
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 2117 S 7TH ST
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City | IRONTON
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State | OH
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Zip | 45638-2538
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Country | US
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Telephone | 740-533-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 REEVES BLVD
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City | ASHLAND
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State | KY
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Zip | 41101-3120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CDCA.166215
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License Number State | OH
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