Provider Demographics
NPI:1386787521
Name:WHEELER, NANCY M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:M
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 REED ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-1337
Mailing Address - Country:US
Mailing Address - Phone:208-226-2399
Mailing Address - Fax:208-478-8341
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3108
Practice Address - Country:US
Practice Address - Phone:208-478-8340
Practice Address - Fax:208-478-8341
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW269151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical