Provider Demographics
NPI:1982123303
Name:GAEDE, BLAIR
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:GAEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 N KEITH CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1410
Mailing Address - Country:US
Mailing Address - Phone:785-545-6940
Mailing Address - Fax:
Practice Address - Street 1:2313 N KEITH CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1410
Practice Address - Country:US
Practice Address - Phone:620-431-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS756106H00000X
KS2986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty