Basic Information
| Provider Information | |||||||||
| NPI: | 1396292918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | DEANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | H. I. S. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WHEELER | ||||||||
| OtherFirstName: | MARILYN | ||||||||
| OtherMiddleName: | DEANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | H. I. S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2230 W. GRANDE BLVD., SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035670028 | ||||||||
| FaxNumber: | 9035670029 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 E. DALLAS STREET | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035670028 | ||||||||
| FaxNumber: | 9035670029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 05/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 11328 | TX | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 80689 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.