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General NPI Number Information
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NPI Number | 1700342490
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Entity Type | Individual
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Provider Name | PHILICIA LASHAUN WHEATLEY
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Gender | Female
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 847 N ROCKWELL ST # 2F
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City | CHICAGO
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State | IL
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Zip | 60622-4553
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Country | US
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Telephone | 785-760-4705
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Fax | 844-308-7900
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Provider Business Mailing Address
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Address Line | 10719 S CALUMET AVE APT 1S
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City | CHICAGO
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State | IL
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Zip | 60628-3649
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Country | US
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Telephone | 773-507-7562
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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