Healthcare Provider Details

I. General information

NPI: 1447166103
Provider Name (Legal Business Name): SAMANTHA LEIGH WHEELER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25390 KRAMERIA ST
MORENO VALLEY CA
92551-2567
US

IV. Provider business mailing address

7450 NORTHROP DR APT 11
RIVERSIDE CA
92508-5003
US

V. Phone/Fax

Practice location:
  • Phone: 951-490-0380
  • Fax:
Mailing address:
  • Phone: 925-285-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP23561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: