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NPI Code Detail

MEDICARE: JENNIFER WELLS MA, LISW, LICDC

MEDICARE: JENNIFER WELLS MA, LISW, LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.2002394-SUPVOH

General Provider Information

NPI Number : 1356840961
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WELLS MA, LISW, LICDC
Provider Business Mailing Address
First Line : 732 BECKMAN ST
Second Line :
City : DAYTON
State : OH
Zip : 45410-2165
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 563 E DOROTHY LN
Second Line :
City : DAYTON
State : OH
Zip : 45419-1805
Country : US
Telephone Number : 937-838-8107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2018
Last Update Date : 06/19/2023

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