Basic Information
Provider Information | |||||||||
NPI: | 1598181844 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WHEELER | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S. CCC-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 708 SUE ANN LN | ||||||||
Address2: |   | ||||||||
City: | BURLESON | ||||||||
State: | TX | ||||||||
PostalCode: | 760286420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8173438179 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5300 ALTAMESA BLVD | ||||||||
Address2: |   | ||||||||
City: | FT WORTH | ||||||||
State: | TX | ||||||||
PostalCode: | 761335924 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8173461800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/11/2014 | ||||||||
LastUpdateDate: | 03/11/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X |   |   | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.