MEDICARE: MS. WHITNIE WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7062	LA

General Provider Information

NPI Number	:	1063149912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WHITNIE WHEELER

Provider Business Mailing Address
First Line	:	11999 LONGRIDGE AVE APT 1202
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-3927
Country	:	US
Telephone Number	:	404-901-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 DOUGLAS AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-2635
Country	:	US
Telephone Number	:	225-355-2106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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