MEDICARE: ELISE WELLER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356680474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE WELLER

Provider Business Mailing Address
First Line	:	5863 NW 72ND ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-1483
Country	:	US
Telephone Number	:	816-984-8280
Fax Number	:	816-984-8281

Provider Business Practice Location Address
First Line	:	5863 NW 72ND ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-1483
Country	:	US
Telephone Number	:	816-984-8280
Fax Number	:	816-984-8281

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

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	02/08/2013

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Directions to “ ELISE WELLER ” Practice Location

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