Provider Demographics
NPI:1396292918
Name:WHEELER, DEANNE (H I S)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:H I S
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:DEANNE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:H I S
Mailing Address - Street 1:2230 W. GRANDE BLVD., SUITE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-567-0028
Mailing Address - Fax:903-567-0029
Practice Address - Street 1:150 E. DALLAS STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103
Practice Address - Country:US
Practice Address - Phone:903-567-0028
Practice Address - Fax:903-567-0029
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11328237700000X
TX80689237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist