Provider Demographics
NPI:1427455245
Name:WELCH, ELIZABETH (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GRIST MILL CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1848
Mailing Address - Country:US
Mailing Address - Phone:508-845-5021
Mailing Address - Fax:
Practice Address - Street 1:59 ACTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4829
Practice Address - Country:US
Practice Address - Phone:508-791-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist