MEDICARE: ELLEN WOLTEMATH MSW

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	101YM0800X	Mental Health Counselor	LH00009344	WA
2	1041C0700X	Clinical Social Worker	LW00008644	WA

General Provider Information

NPI Number	:	1376702894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN WOLTEMATH MSW

Provider Business Mailing Address
First Line	:	18521 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99016-9798
Country	:	US
Telephone Number	:	509-230-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 W FORT GEORGE WRIGHT DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5202
Country	:	US
Telephone Number	:	509-326-8100
Fax Number	:

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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