Provider Demographics
NPI:1609435023
Name:WELCH, COURTNEY DAWN (MS SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DAWN
Last Name:WELCH
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20720 EMPIRE AVE APT 120
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4790
Mailing Address - Country:US
Mailing Address - Phone:541-388-3437
Mailing Address - Fax:
Practice Address - Street 1:326 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2205
Practice Address - Country:US
Practice Address - Phone:541-238-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist