Provider Demographics
NPI:1992213706
Name:WELCH, SHELBY RAE (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:RAE
Last Name:WELCH
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1826
Mailing Address - Country:US
Mailing Address - Phone:928-445-1309
Mailing Address - Fax:928-445-0914
Practice Address - Street 1:812 VALLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1826
Practice Address - Country:US
Practice Address - Phone:928-445-1309
Practice Address - Fax:928-445-0914
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA110412355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant