MEDICARE: WADLE AND ASSOCITES, P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0405	IA

General Provider Information

NPI Number	:	1740458132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WADLE AND ASSOCITES, P.C

Provider Business Mailing Address
First Line	:	2327 70TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-4825
Country	:	US
Telephone Number	:	515-270-1344
Fax Number	:	515-270-6515

Provider Business Practice Location Address
First Line	:	2327 70TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-4825
Country	:	US
Telephone Number	:	515-270-1344
Fax Number	:	515-270-6515

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. SUSAN K MCBROOM
Credential	:	LMHC
Telephone Number	:	515-270-1344

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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