Provider Demographics
NPI:1619290418
Name:WELCHERT, MELINDA K (SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:K
Last Name:WELCHERT
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:360-676-2020
Mailing Address - Fax:360-676-2210
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:360-676-2020
Practice Address - Fax:360-676-2210
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006923101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00006923OtherLICSW