MEDICARE: MRS. WENDA ANN KOLTERMAN LPC

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	101YP2500X	Professional Counselor	19782	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407036270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDA ANN KOLTERMAN LPC

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	LYFORD
State	:	TX
Zip	:	78569-0100
Country	:	US
Telephone Number	:	956-343-1439
Fax Number	:	956-347-3182

Provider Business Practice Location Address
First Line	:	11360 LA COMA ROAD
Second Line	:
City	:	LYFORD
State	:	TX
Zip	:	78569-0100
Country	:	US
Telephone Number	:	956-343-1439
Fax Number	:	956-347-3182

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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