Healthcare Provider Details

I. General information

NPI: 1194275537
Provider Name (Legal Business Name): ANDREA WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 530
DULUTH MN
55802-1724
US

IV. Provider business mailing address

324 W SUPERIOR ST STE 530
DULUTH MN
55802-1724
US

V. Phone/Fax

Practice location:
  • Phone: 218-464-7674
  • Fax: 218-600-5009
Mailing address:
  • Phone: 218-590-9556
  • Fax: 218-600-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number24002
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: