Provider Demographics
NPI:1063567337
Name:WHEATT-DELANCY, LATASHA LAYLA (QMHP, MSW)
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:LAYLA
Last Name:WHEATT-DELANCY
Suffix:
Gender:F
Credentials:QMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 SE 165TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1850
Mailing Address - Country:US
Mailing Address - Phone:503-408-7721
Mailing Address - Fax:
Practice Address - Street 1:3034 NE MLK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3053
Practice Address - Country:US
Practice Address - Phone:503-889-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator