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General NPI Number Information
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NPI Number | 1205623089
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Entity Type | Individual
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Provider Name | ANNIE JO WELCH
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 2812 FAIRVIEW AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113-1308
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Country | US
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Telephone | 612-345-7306
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 ROOSEVELT ST NE
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City | ST ANTHONY
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State | MN
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Zip | 55418-2362
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Country | US
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Telephone | 612-306-1365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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