Provider Demographics
NPI:1700053196
Name:WHEELER, ANNETTE MARIE (MAAUD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MAAUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 DUTCHMANS PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3372
Mailing Address - Country:US
Mailing Address - Phone:502-894-8441
Mailing Address - Fax:502-371-0929
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-894-8441
Practice Address - Fax:502-371-0929
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0370231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100051370Medicaid