Provider Demographics
NPI:1982003919
Name:WHEATON, CAROLYN (QMHA)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:WHEATON
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:WHEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QMHA
Mailing Address - Street 1:PO BOX 12098
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0098
Mailing Address - Country:US
Mailing Address - Phone:503-362-5918
Mailing Address - Fax:503-361-2650
Practice Address - Street 1:2435 GREENWAY DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4535
Practice Address - Country:US
Practice Address - Phone:503-362-4510
Practice Address - Fax:503-361-2650
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator