Provider Demographics
NPI:1881468858
Name:WAKEMAN, WILEY MILLS (LCSW)
Entity type:Individual
Prefix:
First Name:WILEY
Middle Name:MILLS
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772260
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-2260
Mailing Address - Country:US
Mailing Address - Phone:970-439-0078
Mailing Address - Fax:
Practice Address - Street 1:1475 PINE GROVE RD STE 200
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8851
Practice Address - Country:US
Practice Address - Phone:970-439-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99324871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty