Basic Information
| Provider Information | |||||||||
| NPI: | 1689938557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDRES-WADE | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 ELKTON DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809078507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196576471 | ||||||||
| FaxNumber: | 7196312526 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 E EVANS AVE | ||||||||
| Address2: | SUITE 1-260 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802225406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205077351 | ||||||||
| FaxNumber: | 7087954834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY.0004536 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.