Provider Demographics
NPI:1912111204
Name:BARBARA WELLER LICSW LLC
Entity Type:Organization
Organization Name:BARBARA WELLER LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW MSW
Authorized Official - Phone:218-525-2059
Mailing Address - Street 1:5170 MCQUADE ROAD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2943
Mailing Address - Country:US
Mailing Address - Phone:218-525-2059
Mailing Address - Fax:218-525-1864
Practice Address - Street 1:5170 MCQUADE ROAD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2943
Practice Address - Country:US
Practice Address - Phone:218-525-2059
Practice Address - Fax:218-525-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00300103TP2701X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty