Provider Demographics
NPI:1578028882
Name:WHEELER, SAMANTHA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 COUNTY ROAD 1050 N
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62835-2439
Mailing Address - Country:US
Mailing Address - Phone:618-599-4340
Mailing Address - Fax:618-599-4835
Practice Address - Street 1:1764 COUNTY ROAD 1850 N
Practice Address - Street 2:
Practice Address - City:CISNE
Practice Address - State:IL
Practice Address - Zip Code:62823-7774
Practice Address - Country:US
Practice Address - Phone:618-599-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146014759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist