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General NPI Number Information
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NPI Number | 1275349102
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Entity Type | Individual
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Provider Name | JACQUELINE HANSON WHEELER PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 2444 WILSHIRE BLVD STE 620
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City | SANTA MONICA
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State | CA
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Zip | 90403-5828
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Country | US
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Telephone | 424-281-9433
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 2ND ST
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6837
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Country | US
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Telephone | 310-804-4998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NA
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 94026263
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License Number State | CA
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