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General NPI Number Information
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NPI Number | 1033656640
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Entity Type | Individual
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Provider Name | ALEXIS SUZANNE WELLMAN MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 01/22/2017
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Last Update Date | 01/22/2017
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Provider Practice Location Address
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Address Line | 1620 E BROAD ST STE 102
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City | COLUMBUS
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State | OH
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Zip | 43203-2012
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Country | US
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Telephone | 614-684-8243
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Fax | 614-516-0710
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Provider Business Mailing Address
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Address Line | 1047 BRYDEN RD APT 4
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City | COLUMBUS
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State | OH
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Zip | 43205-1897
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Country | US
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Telephone | 917-609-9582
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.1302568
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License Number State | OH
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