Provider Demographics
NPI:1205571072
Name:WELKER, MEGAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WELKER
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 1:1338 W MAUMEE ST APT 90
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1874
Mailing Address - Country:US
Mailing Address - Phone:567-686-6219
Mailing Address - Fax:
Practice Address - Street 1:700 LAKESHIRE TRL
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1565
Practice Address - Country:US
Practice Address - Phone:517-263-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007926235Z00000X
NC30002496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist