Provider Demographics
NPI:1205075512
Name:REBECCA WELKER, MS, CCC-SP, LLC
Entity type:Organization
Organization Name:REBECCA WELKER, MS, CCC-SP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SP
Authorized Official - Phone:623-556-1744
Mailing Address - Street 1:15020 N 142ND LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8745
Mailing Address - Country:US
Mailing Address - Phone:623-556-1744
Mailing Address - Fax:
Practice Address - Street 1:15020 N 142ND LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8745
Practice Address - Country:US
Practice Address - Phone:623-556-1744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty