Provider Demographics
NPI:1568746717
Name:HUNTER WHEELER, TRUDI
Entity Type:Individual
Prefix:
First Name:TRUDI
Middle Name:
Last Name:HUNTER 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 1:17059 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3450
Mailing Address - Country:US
Mailing Address - Phone:708-439-5238
Mailing Address - Fax:708-589-7025
Practice Address - Street 1:17059 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3450
Practice Address - Country:US
Practice Address - Phone:708-439-5238
Practice Address - Fax:708-589-7025
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2411235222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist