Provider Demographics
NPI:1669614087
Name:WELCH, SUSAN E (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:WELCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:HOLZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 WATSON RD
Mailing Address - Street 2:G101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1528
Mailing Address - Country:US
Mailing Address - Phone:314-367-5500
Mailing Address - Fax:314-843-0552
Practice Address - Street 1:9200 WATSON RD
Practice Address - Street 2:G101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1528
Practice Address - Country:US
Practice Address - Phone:314-367-5500
Practice Address - Fax:314-843-0552
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0031351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical