Provider Demographics
NPI:1518316959
Name:WELCH, CHERYL ANN (MS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:WELCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 KENWOOD CTR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1134
Mailing Address - Country:US
Mailing Address - Phone:920-720-8872
Mailing Address - Fax:920-720-8873
Practice Address - Street 1:2462 US HWY 2
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:WI
Practice Address - Zip Code:54121
Practice Address - Country:US
Practice Address - Phone:715-696-6600
Practice Address - Fax:715-696-6601
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3054-226101YP2500X
WI6807-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional