Active NPI
Megan Wade
- Clinical Psychologist
- Detroit, MI
National Provider Identifier
1194230201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301018959
- Practice address
- 4646 John R St
Detroit, MI 48201-1916 - Phone
- (319) 343-8139
- NPI assigned
- Dec 12, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301018959 | MI | Primary |
Addresses
Primary practice location
4646 John R St
Detroit, MI 48201-1916
Mailing address
3644 Knollwood Dr
Beavercreek, OH 45432-2218
Other practice location 1
888 W Big Beaver Rd Ste 780
Troy, MI 48084-4745
Phone (937) 684-2499
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 |
|---|---|---|---|
| 6301018959 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640822400000",
"number": "1194230201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3644 KNOLLWOOD DR",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454322218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482011916",
"telephone_number": "319-343-8139"
}
],
"practiceLocations": [
{
"address_1": "888 W Big Beaver Rd Ste 780",
"address_purpose": "LOCATION",
"city": "Troy",
"state": "MI",
"postal_code": "480844745",
"country_code": "US",
"telephone_number": "937-684-2499",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WADE",
"first_name": "MEGAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-12",
"last_updated": "2021-12-30",
"certification_date": "2021-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301018959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.