Healthcare Provider Details

I. General information

NPI: 1962065151
Provider Name (Legal Business Name): JESSE R WELSH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 E 21ST ST N
WICHITA KS
67214-2249
US

IV. Provider business mailing address

2707 E 21ST ST N
WICHITA KS
67214-2249
US

V. Phone/Fax

Practice location:
  • Phone: 316-691-0249
  • Fax: 316-691-9939
Mailing address:
  • Phone: 316-691-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9922
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: