MEDICARE: WENDY WELTER PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700603735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDY WELTER PLLC

Provider Business Mailing Address
First Line	:	107 MEADOW DR
Second Line	:
City	:	LEXINGTON
State	:	IL
Zip	:	61753-9105
Country	:	US
Telephone Number	:	309-838-7018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 BEECH ST BLDG 7-6
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-1534
Country	:	US
Telephone Number	:	309-838-7018
Fax Number	:

Authorized Official
Title or Position	:	OWNER, SERVICE PROVIDER
Name	:	WENDY WELTER
Credential	:	LCSW
Telephone Number	:	309-838-7018

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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