MEDICARE: MS. AMY KEMP WELLMEIER LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW004187	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CSW004187	OTHER	GA	STATE LICENSE
2	12283	OTHER	MD	STATE LICENCE

General Provider Information

NPI Number	:	1144318932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY KEMP WELLMEIER LCSW-C

Provider Business Mailing Address
First Line	:	42 MDG 300 S. TWININGS ST
Second Line	:	MAXWELL AFB
City	:	MONTGOMERY
State	:	AL
Zip	:	36112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 TWINING ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36112-6027
Country	:	US
Telephone Number	:	334-953-5430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	05/08/2018

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