Provider Demographics
NPI:1245595107
Name:WELCH, NINA JEANNE (MA CCC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:JEANNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 BEACH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2089
Mailing Address - Country:US
Mailing Address - Phone:714-962-6760
Mailing Address - Fax:714-962-5961
Practice Address - Street 1:18700 BEACH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2089
Practice Address - Country:US
Practice Address - Phone:714-962-6760
Practice Address - Fax:714-962-5961
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-6392103K00000X
CASP4303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst