Provider Demographics
NPI:1730436718
Name:WOELLERT, PATRICIA (LISW-S)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WOELLERT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WESLEY AVE STE J
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2276
Mailing Address - Country:US
Mailing Address - Phone:513-531-5110
Mailing Address - Fax:513-531-5668
Practice Address - Street 1:4750 WESLEY AVE STE J
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2276
Practice Address - Country:US
Practice Address - Phone:513-531-5110
Practice Address - Fax:513-531-5668
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI79291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical