Provider Demographics
NPI:1427585298
Name:WELCH, KATHIE
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:32169-1431
Mailing Address - Country:US
Mailing Address - Phone:203-804-9990
Mailing Address - Fax:
Practice Address - Street 1:2060 WINDWARD WAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-1431
Practice Address - Country:US
Practice Address - Phone:203-804-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 15337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA 15337OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH