Provider Demographics
NPI:1033656640
Name:WELLMAN, ALEXIS SUZANNE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SUZANNE
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 BRYDEN RD APT 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1897
Mailing Address - Country:US
Mailing Address - Phone:917-609-9582
Mailing Address - Fax:
Practice Address - Street 1:1620 E BROAD ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-2012
Practice Address - Country:US
Practice Address - Phone:614-684-8243
Practice Address - Fax:614-516-0710
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.13025681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical