Provider Demographics
NPI:1386063428
Name:WHEELER, MAIA
Entity type:Individual
Prefix:
First Name:MAIA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 GREEN BAY RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2238
Mailing Address - Country:US
Mailing Address - Phone:847-814-1096
Mailing Address - Fax:
Practice Address - Street 1:560 GREEN BAY RD STE 10
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2238
Practice Address - Country:US
Practice Address - Phone:847-814-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health