Healthcare Provider Details

I. General information

NPI: 1396837514
Provider Name (Legal Business Name): JUDITH C WHEELER LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CEDAR ST
GIRARD KS
66743-2056
US

IV. Provider business mailing address

911 E CENTENNIAL DR
PITTSBURG KS
66762-6601
US

V. Phone/Fax

Practice location:
  • Phone: 620-724-8806
  • Fax: 620-724-6170
Mailing address:
  • Phone: 620-235-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0575
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: