Provider Demographics
NPI:1255754156
Name:WHEATON, ROBIN LEIGH (MSE, LPC-IT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEIGH
Last Name:WHEATON
Suffix:
Gender:F
Credentials:MSE, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N 25TH ST E
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5269
Mailing Address - Country:US
Mailing Address - Phone:715-394-4173
Mailing Address - Fax:
Practice Address - Street 1:33 N 25TH ST E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5269
Practice Address - Country:US
Practice Address - Phone:715-394-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2036-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional