MEDICARE: TODD A WELLMAN LISW

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	1041C0700X	Clinical Social Worker	I0027872	OH

General Provider Information

NPI Number	:	1972643849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD A WELLMAN LISW

Provider Business Mailing Address
First Line	:	68353 BANNOCK RD
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9736
Country	:	US
Telephone Number	:	740-695-9344
Fax Number	:	740-695-7787

Provider Business Practice Location Address
First Line	:	68353 BANNOCK RD
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9736
Country	:	US
Telephone Number	:	740-695-9344
Fax Number	:	740-695-7787

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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Directions to “ TODD A WELLMAN LISW” Practice Location

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