Provider Demographics
NPI:1962581603
Name:WELTY, JEANNETTE LUCILLE (ACSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:LUCILLE
Last Name:WELTY
Suffix:
Gender:F
Credentials:ACSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1110
Mailing Address - Country:US
Mailing Address - Phone:608-442-1637
Mailing Address - Fax:608-442-1887
Practice Address - Street 1:6417 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1110
Practice Address - Country:US
Practice Address - Phone:608-442-1637
Practice Address - Fax:608-442-1887
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2308-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39657900Medicaid