Healthcare Provider Details

I. General information

NPI: 1962676106
Provider Name (Legal Business Name): PATRICIA WELTY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 FULTON ST SUITE A
ELKHART IN
46514-1927
US

IV. Provider business mailing address

PO BOX 2968
ELKHART IN
46515-2968
US

V. Phone/Fax

Practice location:
  • Phone: 574-296-3200
  • Fax: 574-296-3392
Mailing address:
  • Phone: 574-296-3200
  • Fax: 574-296-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23001120A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: