Active NPI
Wendy Jo Wade, LMFT
- Marriage & Family Therapist
- Isanti, MN
National Provider Identifier
1114217148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1186
- Practice address
- 818 Golden Way NW
Isanti, MN 55040-6508 - Phone
- (763) 444-6647
- NPI assigned
- Apr 11, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1186 | MN | Primary |
Addresses
Primary practice location
818 Golden Way NW
Isanti, MN 55040-6508
Mailing address
39267 Hemingway Ave
North Branch, MN 55056-5352
Phone (952) 261-5335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1186 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302480000000",
"number": "1114217148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39267 HEMINGWAY AVE",
"city": "NORTH BRANCH",
"state": "MN",
"postal_code": "550565352",
"telephone_number": "952-261-5335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "818 GOLDEN WAY NW",
"city": "ISANTI",
"state": "MN",
"postal_code": "550406508",
"telephone_number": "763-444-6647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "WENDY",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-11",
"last_updated": "2011-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Isanti, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.