MEDICARE: ELIZABETH 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	235Z00000X	Speech-Language Pathologist	5581	AL

General Provider Information

NPI Number	:	1578302170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WELLER

Provider Business Mailing Address
First Line	:	3250 INDEPENDENCE DR STE 200
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-4192
Country	:	US
Telephone Number	:	205-767-9207
Fax Number	:	205-502-7171

Provider Business Practice Location Address
First Line	:	3250 INDEPENDENCE DR STE 200
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-4192
Country	:	US
Telephone Number	:	205-767-9207
Fax Number	:	205-502-7171

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

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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Directions to “ ELIZABETH WELLER ” Practice Location

Language	Start Address	Practice Location

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