Healthcare Provider Details

I. General information

NPI: 1538227756
Provider Name (Legal Business Name): SEVERIN G WELLINGHOFF PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 GATEWAY BLVD
NEWBURGH IN
47630-8900
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-7391
  • Fax: 812-858-6460
Mailing address:
  • Phone: 812-853-7391
  • Fax: 812-858-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040556A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: