Provider Demographics
NPI:1164995452
Name:WHEELER, JAMES WILLIAM
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 ROCKFORD RD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1868
Mailing Address - Country:US
Mailing Address - Phone:319-560-3393
Mailing Address - Fax:
Practice Address - Street 1:1073 ROCKFORD RD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1868
Practice Address - Country:US
Practice Address - Phone:319-774-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1689094112Medicaid