| Kathy Wade | |
|
1809 Michelle Ct Ann Arbor MI 48105-9253 | |
| (734) 717-4186 | |
| Not Available |
| Full Name | Kathy Wade |
|---|---|
| Speciality | Social Worker |
| Location | 1809 Michelle Ct, Ann Arbor, Michigan |
| Authorized Official Name and Position | Jennifer Heckendorn (BILLER) |
| Authorized Official Contact | 7342740536 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathy Wade 1809 Michelle Ct Ann Arbor MI 48105-9253 Ph: (734) 717-4186 | Kathy Wade 1809 Michelle Ct Ann Arbor MI 48105-9253 Ph: (734) 717-4186 |
| NPI Number | 1245949890 |
|---|---|
| Provider Enumeration Date | 11/22/2022 |
| Last Update Date | 10/03/2023 |
| Certification Date | 10/03/2023 |
| Medicare PECOS PAC ID | 3678927753 |
|---|---|
| Medicare Enrollment ID | O20230922001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245949890 | NPI | - | NPPES |
| 0014440 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kathleen M Wade |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720526718 PECOS PAC ID: 3173784824 Enrollment ID: I20230913000741 |
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