Provider Demographics
NPI:1699714154
Name:WELCH, CONNIE (MHS)
Entity type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4457
Mailing Address - Country:US
Mailing Address - Phone:417-532-5725
Mailing Address - Fax:
Practice Address - Street 1:679 W ELM ST
Practice Address - Street 2:#2
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3585
Practice Address - Country:US
Practice Address - Phone:417-588-4275
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist