Provider Demographics
NPI:1851952006
Name:WADE, JACQUELINE SUROS (SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUROS
Last Name:WADE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:SUROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 RIVER BIRCH GROVE RD APT 203
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-0338
Mailing Address - Country:US
Mailing Address - Phone:908-442-3080
Mailing Address - Fax:
Practice Address - Street 1:959 MERRIMON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2466
Practice Address - Country:US
Practice Address - Phone:828-417-7085
Practice Address - Fax:828-417-7059
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist