Provider Demographics
NPI:1366830879
Name:SCHEELER, ELIZABETH C (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:SCHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43395 HEAVENS LN
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9490
Mailing Address - Country:US
Mailing Address - Phone:541-969-9195
Mailing Address - Fax:
Practice Address - Street 1:920 SW FRAZER AVE STE 111
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2800
Practice Address - Country:US
Practice Address - Phone:541-969-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL79091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500713990Medicaid