Healthcare Provider Details

I. General information

NPI: 1538945019
Provider Name (Legal Business Name): EMILY REBECCA WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

IV. Provider business mailing address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

V. Phone/Fax

Practice location:
  • Phone: 617-970-3044
  • Fax:
Mailing address:
  • Phone: 617-970-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144791
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: