Provider Demographics
NPI:1861546418
Name:WELDELE, DAVID J (AUD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:WELDELE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3617
Mailing Address - Country:US
Mailing Address - Phone:440-282-4300
Mailing Address - Fax:440-960-5562
Practice Address - Street 1:1618 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3617
Practice Address - Country:US
Practice Address - Phone:440-282-4300
Practice Address - Fax:440-960-5562
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01451231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085287Medicaid
OH00000035896OtherANTHEM
OH0085287Medicaid