Jacqueline Wade, PHD LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2531-C Issued in NV

Practice address

2620 Regatta Dr Ste 102
Las Vegas, NV 89128-6892

Phone

(702) 751-2408

NPI assigned

Apr 17, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1134549041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 REGATTA DR STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891286892",
            "telephone_number": "702-751-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 REGATTA DR STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891286892",
            "telephone_number": "702-751-2408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5516 S Fort Apache Rd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891487678",
            "country_code": "US",
            "telephone_number": "702-646-0188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "PHD LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-17",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "2531-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134549041",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eporre'Ya Wade
• Eric Wade
• Felesia Wade
• Geoffrey A Wade, MD
• Gineah A Wade
• Jenna L Wade
• Kailyn Wade Wade, CF-SLP
• Marcus Wade
• Melanie Wade
• Melissa Wade

• Clinical Social Worker in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.