Provider Demographics
NPI:1487790564
Name:WHEATON COLLEGE
Entity type:Organization
Organization Name:WHEATON COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVOST OF WHEATON COLLEGE
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-752-5004
Mailing Address - Street 1:800 CENTENNIAL DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4242
Mailing Address - Country:US
Mailing Address - Phone:630-752-5072
Mailing Address - Fax:630-752-5575
Practice Address - Street 1:800 CENTENNIAL DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4242
Practice Address - Country:US
Practice Address - Phone:630-752-5072
Practice Address - Fax:630-752-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)