MEDICARE: JACQUELINE SUROS WADE SLP

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	235Z00000X	Speech-Language Pathologist	30002405	NC

General Provider Information

NPI Number	:	1851952006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SUROS WADE SLP

Provider Business Mailing Address
First Line	:	139 RIVER BIRCH GROVE RD APT 203
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28806-0338
Country	:	US
Telephone Number	:	908-442-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 YORKSHIRE ST STE D
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28803-2768
Country	:	US
Telephone Number	:	828-417-7085
Fax Number	:	828-417-7059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	10/29/2025

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Directions to “ JACQUELINE SUROS WADE SLP” Practice Location

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