Provider Demographics
NPI:1447317375
Name:WAKELING, SHERYL LYNNE (MA QMHP LPC)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:LYNNE
Last Name:WAKELING
Suffix:
Gender:F
Credentials:MA QMHP LPC
Other - Prefix:MS
Other - First Name:SHERYL
Other - Middle Name:LYNNE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA QMHP LPC
Mailing Address - Street 1:2235 SW ROXBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5142
Mailing Address - Country:US
Mailing Address - Phone:503-957-6244
Mailing Address - Fax:
Practice Address - Street 1:1118 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4019
Practice Address - Country:US
Practice Address - Phone:503-585-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
ORC3508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist