MEDICARE: WENDY S MIKOLICH 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	SW134277	PA

General Provider Information

NPI Number	:	1922776889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY S MIKOLICH LSW

Provider Business Mailing Address
First Line	:	2517 BEDFORD ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-1424
Country	:	US
Telephone Number	:	814-241-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 BEDFORD ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-1424
Country	:	US
Telephone Number	:	814-241-7990
Fax Number	:

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

Provider Enumeration Date	:	09/03/2021
Last Update Date	:	09/03/2021

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