Provider Demographics
NPI:1073195798
Name:WELSHER, STACEY DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:DIANE
Last Name:WELSHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:LURAAS
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:790 N CUTLER DR APT C103
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-5082
Mailing Address - Country:US
Mailing Address - Phone:385-258-7859
Mailing Address - Fax:
Practice Address - Street 1:790 N CUTLER DR APT C103
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-5082
Practice Address - Country:US
Practice Address - Phone:385-258-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date: