Provider Demographics
NPI:1245813039
Name:WELTER, MANDI SUE (ST)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:SUE
Last Name:WELTER
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:SUE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:1915 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8768
Mailing Address - Country:US
Mailing Address - Phone:319-480-9915
Mailing Address - Fax:515-727-8757
Practice Address - Street 1:1915 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8768
Practice Address - Country:US
Practice Address - Phone:515-232-7220
Practice Address - Fax:515-727-8757
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist