| Jessica Welch Llc | |
|
12 Elm St Gorham ME 04038-1506 | |
| (207) 370-1282 | |
| Not Available |
| Full Name | Jessica Welch Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12 Elm St, Gorham, Maine |
| Authorized Official Name and Position | Jessica Welch (OWNER) |
| Authorized Official Contact | 2073330330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Welch Llc 151 Old Portland Rd North Waterboro ME 04061-4901 Ph: (207) 333-0330 | Jessica Welch Llc 12 Elm St Gorham ME 04038-1506 Ph: (207) 370-1282 |
| NPI Number | 1588311385 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 03/02/2022 |
| Certification Date | 03/02/2022 |
| Medicare PECOS PAC ID | 4789070392 |
|---|---|
| Medicare Enrollment ID | O20220407001916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588311385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jessica M Welch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588111942 PECOS PAC ID: 8628404548 Enrollment ID: I20200212000567 |
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