MEDICARE: WELLNES SERVICES

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

General Provider Information

NPI Number	:	1851677249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNES SERVICES

Provider Business Mailing Address
First Line	:	2934 UNION ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5139
Country	:	US
Telephone Number	:	608-228-0979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2934 UNION ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5139
Country	:	US
Telephone Number	:	608-228-0979
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMMY L SYTSMA
Credential	:
Telephone Number	:	608-228-0979

Provider Enumeration Date	:	10/29/2011
Last Update Date	:	10/29/2011

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Directions to “WELLNES SERVICES ” Practice Location

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