1437227386 NPI number — MR. JASON SCOTT WHEATLEY LMSW

Table of content: MR. JASON SCOTT WHEATLEY LMSW (NPI 1437227386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437227386 NPI number — MR. JASON SCOTT WHEATLEY LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEATLEY
Provider First Name:
JASON
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHEATLEY
Provider Other First Name:
JASON
Provider Other Middle Name:
SCOTT
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LISW-S
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437227386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 ELDON BAKER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-1923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-213-1803
Provider Business Mailing Address Fax Number:
810-744-1306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1136 WILMINGTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-254-6700
Provider Business Practice Location Address Fax Number:
937-254-6776
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801086655 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: I0500089 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)