Provider Demographics
NPI:1053835835
Name:WELCH, SCOTT RICHARD
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W SPRUCE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4029
Mailing Address - Country:US
Mailing Address - Phone:406-543-5690
Mailing Address - Fax:
Practice Address - Street 1:712 W SPRUCE ST STE 2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4029
Practice Address - Country:US
Practice Address - Phone:406-543-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTHAD-HAD-LIC-1369237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist