Provider Demographics
NPI:1336824291
Name:WELCH, DYLAN NICOLE (CF - SLP)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:NICOLE
Last Name:WELCH
Suffix:
Gender:F
Credentials:CF - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 COMMERCIAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8856
Mailing Address - Country:US
Mailing Address - Phone:850-353-2415
Mailing Address - Fax:850-353-2528
Practice Address - Street 1:4565 COMMERCIAL DR STE 105
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8856
Practice Address - Country:US
Practice Address - Phone:850-353-2415
Practice Address - Fax:850-353-2528
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist