Provider Demographics
NPI:1952528614
Name:WELCH, CAROLYN (MS, LAC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 SUNSET HWY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7785 SUNSET HWY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4061
Practice Address - Country:US
Practice Address - Phone:206-369-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002954171100000X, 171100000X
WARN00113658163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC00002954OtherLICENSED ACUPUNCTURIST
WA028471OtherDIPL. AC., NCCAOM
WA8045OtherNADA CERTIFIED, DETOXIFICATION SPECIALIST
WAEIN 205260849OtherTHE SECOND CYCLE PLLC
WARN00113658OtherREGISTERED NURSE