Provider Demographics
NPI:1891992467
Name:WHEELER, JOHN ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19105 36TH AVE W
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5760
Mailing Address - Country:US
Mailing Address - Phone:425-771-0970
Mailing Address - Fax:425-771-0970
Practice Address - Street 1:19105 36TH AVE W
Practice Address - Street 2:SUITE 206
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5760
Practice Address - Country:US
Practice Address - Phone:425-771-0970
Practice Address - Fax:425-771-0970
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1132103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic