Healthcare Provider Details

I. General information

NPI: 1730395013
Provider Name (Legal Business Name): EVELYN ROXANNE WHEAT MS, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 DORIS RD
AUBURN HILLS MI
48326-2617
US

IV. Provider business mailing address

1270 DORIS RD
AUBURN HILLS MI
48326-2617
US

V. Phone/Fax

Practice location:
  • Phone: 248-276-8000
  • Fax:
Mailing address:
  • Phone: 248-276-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301003396
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301003396
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6301003396
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: