| Doctor Name: | MR. GARY WADE |
| NPI Number: | 1598886624 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.S.W. |
| License Number: | LCSW-120 |
| Business Practice Address: | 137 S State St Rigby, ID - 834421449 |
| Business Phone Number: | 2087450150 |
| Business Fax Number: | |
| Mailing Address: | 137 S State St, RIGBY |
| State: | ID |
| Postal Code: | 834421449 |
| Phone Number: | 2087450150 |
| Fax Number: | |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW-120 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |