Provider Demographics
NPI:1083656987
Name:WELKER, ROBERT L (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:WELKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W COVENTRY CT
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3972
Mailing Address - Country:US
Mailing Address - Phone:414-351-7726
Mailing Address - Fax:414-351-7721
Practice Address - Street 1:250 W COVENTRY CT
Practice Address - Street 2:SUITE 209
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3972
Practice Address - Country:US
Practice Address - Phone:414-351-7726
Practice Address - Fax:414-351-7721
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1380103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39076100Medicaid
WI39076100Medicaid