Provider Demographics
NPI:1871184200
Name:WHEELAND, KRISTINA JO (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JO
Last Name:WHEELAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 SAN GABRIEL APT B
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8468
Mailing Address - Country:US
Mailing Address - Phone:269-870-7111
Mailing Address - Fax:
Practice Address - Street 1:232 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9631
Practice Address - Country:US
Practice Address - Phone:231-652-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6968-1231041C0700X
MI68010577401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical