Provider Demographics
NPI:1346462744
Name:WELCH, JILL D (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:D
Last Name:WELCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11413 COUNTY ROAD 60
Mailing Address - Street 2:
Mailing Address - City:HAVILAND
Mailing Address - State:OH
Mailing Address - Zip Code:45851-9623
Mailing Address - Country:US
Mailing Address - Phone:419-399-3466
Mailing Address - Fax:419-238-3612
Practice Address - Street 1:1119 WESTWOOD DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1473
Practice Address - Country:US
Practice Address - Phone:888-557-1200
Practice Address - Fax:419-238-3612
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 6779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000362509OtherANTHEM PIN #