Stefanie G Wade, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20042314A Issued in IN

Practice address

313 S 3Rd St
Goshen, IN 46526-3709

Phone

(574) 535-0880

Fax

(574) 535-0882

NPI assigned

Mar 29, 2007

Last updated

Dec 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wade Psychological Services Inc.

  • Clinical Psychologist
  • Goshen, IN
  • NPI 1104139682
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1841310471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 W LINCOLN AVE",
            "address_2": "STE 2",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265964",
            "telephone_number": "574-535-0880",
            "fax_number": "574-535-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 S 3RD ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465263709",
            "telephone_number": "574-535-0880",
            "fax_number": "574-535-0882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "STEFANIE",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042314A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200938090A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Mae Vanderveer, DPT
• Yessica Veloz
• Urs W Von Holzen, MD
• Wade Psychological Services Inc.
• Ginger Renee Wade, APRN
• Karl Thomas Wagner Jr., MD
• Liza Wakley
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1378)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1566)
• Wal-Mart Stores East, LP (Walmart Vision Center 30-1566)

• 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 Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.