MEDICARE: LEAH RENAE WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1235848839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH RENAE WHEELER

Provider Business Mailing Address
First Line	:	3723 26 1/2 AVE N
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-3703
Country	:	US
Telephone Number	:	763-746-6769
Fax Number	:

Provider Business Practice Location Address
First Line	:	3427 CENTRAL AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-1221
Country	:	US
Telephone Number	:	763-746-6769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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Directions to “ LEAH RENAE WHEELER ” Practice Location

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