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General NPI Number Information
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NPI Number | 1316081276
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Entity Type | Individual
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Provider Name | KEN R WELLING CSACFA
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17171 BOTHELL WAY NE STE 281
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-5534
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Country | US
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Telephone | 206-261-2992
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Fax | 206-417-5518
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Provider Business Mailing Address
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Address Line | 17171 BOTHELL WAY NE STE 281
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-5534
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Country | US
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Telephone | 206-261-2992
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Fax | 206-417-5518
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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