Provider Demographics
NPI:1457483794
Name:WELCH, JUDITH JOHNSON (MA)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JOHNSON
Last Name:WELCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5515
Mailing Address - Country:US
Mailing Address - Phone:504-834-0313
Mailing Address - Fax:504-834-0313
Practice Address - Street 1:525 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5515
Practice Address - Country:US
Practice Address - Phone:504-834-0313
Practice Address - Fax:504-834-0313
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAJ8494QHMedicaid