MEDICARE: KATRINA MARIE WELLMAN

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.2403515-TRNE	OH

General Provider Information

NPI Number	:	1730999277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA MARIE WELLMAN

Provider Business Mailing Address
First Line	:	3477 REBERT PIKE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45502-9737
Country	:	US
Telephone Number	:	707-292-8922
Fax Number	:

Provider Business Practice Location Address
First Line	:	3477 REBERT PIKE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45502-9737
Country	:	US
Telephone Number	:	707-292-8922
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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Directions to “ KATRINA MARIE WELLMAN ” Practice Location

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