Provider Demographics
NPI:1053980722
Name:WHEELER, ERIN PAIGE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:PAIGE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 ALEXANDER LOOP APT 5119
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6589
Mailing Address - Country:US
Mailing Address - Phone:541-290-5161
Mailing Address - Fax:
Practice Address - Street 1:2490 WILLAMETTE ST STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-7211
Practice Address - Country:US
Practice Address - Phone:503-927-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIN-10215232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst