Provider Demographics
NPI:1003406885
Name:WHEELER, COLLENE ELIZABETH (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:COLLENE
Middle Name:ELIZABETH
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-1952
Mailing Address - Country:US
Mailing Address - Phone:218-966-4464
Mailing Address - Fax:
Practice Address - Street 1:2729 13TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2314
Practice Address - Country:US
Practice Address - Phone:218-293-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN277851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical