Provider Demographics
NPI:1063604197
Name:WELSCH, ROBERT THEODORE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THEODORE
Last Name:WELSCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15726 S FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5535
Mailing Address - Country:US
Mailing Address - Phone:815-577-6686
Mailing Address - Fax:
Practice Address - Street 1:15726 S FREDERICK ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5535
Practice Address - Country:US
Practice Address - Phone:815-577-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical