Provider Demographics
NPI:1164304226
Name:WADE, HEATHER LYNNE (BA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNE
Last Name:WADE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNNE
Other - Last Name:DUNMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1047 S WELLS ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7997
Mailing Address - Country:US
Mailing Address - Phone:208-297-3428
Mailing Address - Fax:
Practice Address - Street 1:11900 SHELBURNE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-7966
Practice Address - Country:US
Practice Address - Phone:208-515-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator