Provider Demographics
NPI:1497495022
Name:WADE, HANNAH RUTHANN (MED, BCBA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:RUTHANN
Last Name:WADE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 SHADOW GLENN DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2258
Mailing Address - Country:US
Mailing Address - Phone:832-671-9539
Mailing Address - Fax:
Practice Address - Street 1:2174 N FM-3083 RD W
Practice Address - Street 2:SUITE 300
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-315-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-209646106S00000X
TX1-25-79600103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician