Provider Demographics
NPI:1285918698
Name:WELSER, EILEEN HEENAN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:HEENAN
Last Name:WELSER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N PROSPECT AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3227
Mailing Address - Country:US
Mailing Address - Phone:310-944-9252
Mailing Address - Fax:
Practice Address - Street 1:21615 HAWTHORNE BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-371-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist