Provider Demographics
NPI:1396035531
Name:WELCH, SANDRA L (SLP-A)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:WELCH
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BENTON AVE.
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-3004
Mailing Address - Country:US
Mailing Address - Phone:207-872-1967
Mailing Address - Fax:
Practice Address - Street 1:285 BENTON AVE.
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-3004
Practice Address - Country:US
Practice Address - Phone:207-872-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2355S0801X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant