Wade Psychological Services Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20042314A Issued in IN

Legal business name

WADE PSYCHOLOGICAL SERVICES INC.

Practice address

1930 W Lincoln Ave
Goshen, IN 46526-5907

Phone

(574) 534-2161

Fax

(574) 534-3887

NPI assigned

Jul 26, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stefanie Wade, PSYD, HSPPNPI 1841310471

Title

Owner

Phone

(574) 534-2161

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stefanie G Wade, PSYD

  • Clinical Psychologist
  • Goshen, IN
  • NPI 1841310471
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280102400000",
    "number": "1104139682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 W LINCOLN AVE",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265907",
            "telephone_number": "574-534-2161",
            "fax_number": "574-534-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 W LINCOLN AVE",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265907",
            "telephone_number": "574-534-2161",
            "fax_number": "574-534-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADE PSYCHOLOGICAL SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-26",
        "last_updated": "2010-07-26",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-534-2161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, HSPP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042314A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200938090A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Lynn Vander Reyden, FNP
• Lauren Isabella Vanderreyden, OD
• Emily Mae Vanderveer, DPT
• Yessica Veloz
• Urs W Von Holzen, MD
• Ginger Renee Wade, APRN
• Stefanie G Wade, PSYD
• Karl Thomas Wagner Jr., MD
• Liza Wakley
• Wal-Mart Stores East LP

• Clinical Psychologist in Goshen, IN
• Providers in Goshen, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.