Provider Demographics
NPI:1962820464
Name:WHEELER, NANCY JEAN (SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:MICKELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1850 BOYER AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2922
Mailing Address - Country:US
Mailing Address - Phone:206-325-8477
Mailing Address - Fax:206-323-1385
Practice Address - Street 1:1850 BOYER AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-2922
Practice Address - Country:US
Practice Address - Phone:206-325-8477
Practice Address - Fax:206-323-1385
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60271750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7020464Medicaid