Provider Demographics
NPI:1053628537
Name:EVANS-WELPE, MARY
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:EVANS-WELPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13668-3238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7229 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NY
Practice Address - Zip Code:13668-3238
Practice Address - Country:US
Practice Address - Phone:315-353-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist