Provider Demographics
NPI:1912207002
Name:WELCH, LISA A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WELCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RENAISSANCE PL UNIT 118
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-3636
Mailing Address - Country:US
Mailing Address - Phone:847-705-1216
Mailing Address - Fax:
Practice Address - Street 1:1 RENAISSANCE PL UNIT 118
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-3636
Practice Address - Country:US
Practice Address - Phone:847-705-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist