MEDICARE: MS. GWENDOLYN ESME WORLEY

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
1	101YM0800X	Mental Health Counselor	3933-226	WI

General Provider Information

NPI Number	:	1366937492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENDOLYN ESME WORLEY

Provider Business Mailing Address
First Line	:	385 WILLIAMSTOWNE STE 302
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2323
Country	:	US
Telephone Number	:	608-620-4028
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 WILLIAMSTOWNE STE 302
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2323
Country	:	US
Telephone Number	:	608-620-4028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2018
Last Update Date	:	08/22/2024

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