Provider Demographics
NPI:1053850289
Name:WELTE, KATHRYN JANE (MA, CCC, SLP, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JANE
Last Name:WELTE
Suffix:
Gender:F
Credentials:MA, CCC, SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28101 COOKSTOWN CT UNIT 4402
Mailing Address - Street 2:UNIT 4402
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8797
Mailing Address - Country:US
Mailing Address - Phone:201-707-9587
Mailing Address - Fax:
Practice Address - Street 1:28101 COOKSTOWN CT
Practice Address - Street 2:UNIT 4402
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8796
Practice Address - Country:US
Practice Address - Phone:201-707-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 15068235Z00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist