Provider Demographics
NPI:1023478781
Name:WADE, J'MIA KAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:J'MIA
Middle Name:KAE
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:J'MIA
Other - Middle Name:KAE
Other - Last Name:ALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2282 PROVIDENCE PT LN APT 203
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-1783
Mailing Address - Country:US
Mailing Address - Phone:336-817-9982
Mailing Address - Fax:
Practice Address - Street 1:2282 PROVIDENCE PT LN APT 203
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-1783
Practice Address - Country:US
Practice Address - Phone:336-817-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist