Provider Demographics
NPI:1053679373
Name:WELCH, TIMOTHY MICHAL (HID)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAL
Last Name:WELCH
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N 1ST ST
Mailing Address - Street 2:#211
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1133
Mailing Address - Country:US
Mailing Address - Phone:612-910-3971
Mailing Address - Fax:
Practice Address - Street 1:3603 ROUND LAKE BLVD NW
Practice Address - Street 2:SUITE #102
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-5054
Practice Address - Country:US
Practice Address - Phone:763-450-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2701237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist