Provider Demographics
NPI:1508755372
Name:WHEELER, KATHRYN COSTELLO
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COSTELLO
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1344
Mailing Address - Country:US
Mailing Address - Phone:971-601-5439
Mailing Address - Fax:
Practice Address - Street 1:9901 NE 7TH AVE STE C116
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4528
Practice Address - Country:US
Practice Address - Phone:360-571-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician