Healthcare Provider Details

I. General information

NPI: 1669193645
Provider Name (Legal Business Name): CARLY WELSH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 JOHNSTOWN RD
CHESAPEAKE VA
23322-5356
US

IV. Provider business mailing address

1015 CHATTANOOGA ST
CHESAPEAKE VA
23322-7308
US

V. Phone/Fax

Practice location:
  • Phone: 631-356-2393
  • Fax:
Mailing address:
  • Phone: 631-356-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001023
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: