Provider Demographics
NPI:1205623089
Name:WELCH, ANNIE JO
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:JO
Last Name:WELCH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 ROOSEVELT ST NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2362
Mailing Address - Country:US
Mailing Address - Phone:612-306-1365
Mailing Address - Fax:
Practice Address - Street 1:2812 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1308
Practice Address - Country:US
Practice Address - Phone:612-345-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician