Add Language Spoken by Office and Language Services Available

Product Selection * WellCare (Medicare) Ambetter (Maketplace) Delaware First Health (Medicaid)

Group Name *

Group NPI # *

Additional Language(s) Spoken (select all that apply): *

List Other Languages (if applicable)

Language(s) No Longer Spoken (select all that apply): *

List Other Languages No Longer Spoken (if applicable)

Language Services Available (check one) * Bilingual staff or Interpreters (on-site interpreters and/or remote video or telephone interpreters) and/or American sign language No Language Services Available

Comments

Update Requested By:

First Name *

Last Name *

Professional Title *

Contact Email *

Date *

Contact Phone Number *