Individual
KELLY ELIZABETH WELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
443 OAK GROVE CIR, WAUCONDA, IL 60084-3904
(224) 456-3601
Mailing address
443 OAK GROVE CIR, WAUCONDA, IL 60084-3904
(224) 456-3601
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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