Provider Demographics
NPI:1689904047
Name:WHEELER, LESA SIMONE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:SIMONE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3645
Mailing Address - Country:US
Mailing Address - Phone:541-579-4114
Mailing Address - Fax:
Practice Address - Street 1:710 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3645
Practice Address - Country:US
Practice Address - Phone:541-579-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL56031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical