Healthcare Provider Details

I. General information

NPI: 1699222489
Provider Name (Legal Business Name): LACEY WHEELER MSW, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S COLUMBIAN WAY
SEATTLE WA
98108-1565
US

IV. Provider business mailing address

1600 S COLUMBIAN WAY
SEATTLE WA
98108-1565
US

V. Phone/Fax

Practice location:
  • Phone: 206-227-1287
  • Fax: 206-764-2192
Mailing address:
  • Phone: 206-227-1287
  • Fax: 206-764-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60249692
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC60643039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: