Provider Demographics
NPI:1073813085
Name:WHEELER, SANDRA JANE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANEY
Other - Middle Name:STEWART
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11008 N ANN ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5917
Mailing Address - Country:US
Mailing Address - Phone:405-595-8941
Mailing Address - Fax:405-721-8642
Practice Address - Street 1:2460 W I 44 SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8703
Practice Address - Country:US
Practice Address - Phone:405-951-3312
Practice Address - Fax:405-943-7177
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional