Kelly Jo Medeiros-Wheeler, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L4416 Issued in OR

Practice address

21887 SW Sherwood Blvd Ste C
Sherwood, OR 97140-9459

Phone

(503) 966-4154

Fax

(503) 506-0628

NPI assigned

Nov 1, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Cornelius, OR
  • NPI 1679528012
  Medicare reassignment NPD (past)
• Sequoia Mental Health Services Inc

  • Community/Behavioral Health Agency
  • Aloha, OR
  • NPI 1730167982
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784246400000",
    "number": "1508166919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21370 SW LANGER FARMS PKWY STE 142",
            "address_2": "PMB-414",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "97140",
            "telephone_number": "503-966-4154",
            "fax_number": "503-506-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21887 SW SHERWOOD BLVD STE C",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409459",
            "telephone_number": "503-966-4154",
            "fax_number": "503-506-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEIROS-WHEELER",
        "first_name": "KELLY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-01",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500658417",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trevor Martin, DMD
• Makenzie Maurice, LMT
• Cristela Corazon McAravey, DNP-FNP C
• Kathryn Marie McConkie
• Melissa McMurry, MA, LPC, CADC I
• Alyssa Gabrielle Menle, LMT
• Rebecca Ann Mickel, FNP
• Hannah Mickelson, PA
• Lisa Middleton, LMT
• Patricia Eden Fernandez Millan, M.D.

• Clinical Social Worker in Sherwood, OR
• Providers in Sherwood, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.