Ivy Charlotte Wade

NPI #1972212561 in Ardmore, Oklahoma

Provider Information

NPI Number: 1972212561
Entity Type: Individual
Name: Ivy Charlotte Wade
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Case Manager/Care Coordinator
Enumeration Date: Nov 22, 2022
Last Updated: May 22, 2023

Practice Location

Address: 2530 S COMMERCE ST BLDG B
City: Ardmore
State: Oklahoma
ZIP Code: 73401-5519
Phone: (802) 265-0485

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X	Primary
Counselor - Mental Health — Mental Health	101YM0800X

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