Provider Demographics
NPI:1417516758
Name:WHEELER, LILLIE M (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:M
Last Name:WHEELER
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-6401
Mailing Address - Country:US
Mailing Address - Phone:757-535-5802
Mailing Address - Fax:
Practice Address - Street 1:4201 HAWKSLEY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5427
Practice Address - Country:US
Practice Address - Phone:757-638-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist