MEDICARE: JHEREL A WELLS SR. MSW, LSW

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	104100000X	Social Worker	S.1201496	OH

General Provider Information

NPI Number	:	1700444577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHEREL A WELLS SR. MSW, LSW

Provider Business Mailing Address
First Line	:	4836 MONTICELLO BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2846
Country	:	US
Telephone Number	:	216-338-2898
Fax Number	:	216-486-6112

Provider Business Practice Location Address
First Line	:	4836 MONTICELLO BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2846
Country	:	US
Telephone Number	:	216-338-2898
Fax Number	:	216-486-6112

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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