MEDICARE: HALEY WHEELER LCSW

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	1041C0700X	Clinical Social Worker	74769	CA

General Provider Information

NPI Number	:	1528502770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY WHEELER LCSW

Provider Business Mailing Address
First Line	:	46 SHOPPING PLZ # 1056
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3022
Country	:	US
Telephone Number	:	602-295-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 ROYAL OAK DR
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-4135
Country	:	US
Telephone Number	:	602-295-2620
Fax Number	:

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	02/20/2023

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