Provider Demographics
NPI:1508509704
Name:WELTJEN, ANNA CATHERINE (MSED SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CATHERINE
Last Name:WELTJEN
Suffix:
Gender:F
Credentials:MSED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ASHLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2600
Mailing Address - Country:US
Mailing Address - Phone:716-491-6580
Mailing Address - Fax:716-662-5700
Practice Address - Street 1:780 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2010
Practice Address - Country:US
Practice Address - Phone:716-816-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP116470235Z00000X
NY032985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist