Provider Demographics
NPI:1881976744
Name:WELCH, ELISABETH ANNE (CMT)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 BAYBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-5419
Mailing Address - Country:US
Mailing Address - Phone:970-227-3693
Mailing Address - Fax:
Practice Address - Street 1:605 1/2 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3003
Practice Address - Country:US
Practice Address - Phone:970-227-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist