Healthcare Provider Details

I. General information

NPI: 1912111204
Provider Name (Legal Business Name): BARBARA WELLER LICSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 MCQUADE ROAD
DULUTH MN
55804-2943
US

IV. Provider business mailing address

5170 MCQUADE ROAD
DULUTH MN
55804-2943
US

V. Phone/Fax

Practice location:
  • Phone: 218-525-2059
  • Fax: 218-525-1864
Mailing address:
  • Phone: 218-525-2059
  • Fax: 218-525-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number00300
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00300
License Number StateMN

VIII. Authorized Official

Name: BARBARA J WELLER
Title or Position: OWNER
Credential: LICSW MSW
Phone: 218-525-2059