Provider Demographics
NPI:1336234764
Name:WELKER, REBECCA DIANE (MS,CCC-SP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:WELKER
Suffix:
Gender:F
Credentials:MS,CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15020 N. 142ND LANE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:623-556-1744
Mailing Address - Fax:623-556-1863
Practice Address - Street 1:15020 N. 142ND LANE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-556-1744
Practice Address - Fax:623-556-1863
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist