Provider Demographics
NPI:1295067312
Name:WHEELER, ASHLEY LYNN (LLMSW, SSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LLMSW, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19908 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49346-9505
Mailing Address - Country:US
Mailing Address - Phone:231-580-9085
Mailing Address - Fax:
Practice Address - Street 1:212 1/2 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1806
Practice Address - Country:US
Practice Address - Phone:231-796-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091774104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker