Provider Demographics
NPI:1437593738
Name:WHEELOCK, DORINDA SUE
Entity Type:Individual
Prefix:MRS
First Name:DORINDA
Middle Name:SUE
Last Name:WHEELOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DINDY
Other - Middle Name:
Other - Last Name:WHEELOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11650 PERRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6536
Mailing Address - Country:US
Mailing Address - Phone:951-488-0404
Mailing Address - Fax:
Practice Address - Street 1:11650 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6536
Practice Address - Country:US
Practice Address - Phone:951-488-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist