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NPI Code Detail

MEDICARE: ELLIOTT WEDAM

MEDICARE:   ELLIOTT  WEDAM
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1710744198
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIOTT WEDAM
Provider Business Mailing Address
First Line : 1453 MCCLELLAN DR
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97603-4143
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3815 S 6TH ST STE 108
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97603-4758
Country : US
Telephone Number : 675-054-1205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2024
Last Update Date : 03/04/2024

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Directions to “ ELLIOTT WEDAM ” Practice Location

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