Provider Demographics
NPI:1467530030
Name:WELCH, GRETCHEN KATRINA (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:KATRINA
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16564 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6419
Mailing Address - Country:US
Mailing Address - Phone:320-632-3605
Mailing Address - Fax:
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:#104
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-529-0862
Practice Address - Fax:320-654-8875
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN98091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical