MEDICARE: ELLA WELCH MS, MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1044-228	WI

General Provider Information

NPI Number	:	1619735107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA WELCH MS, MFT

Provider Business Mailing Address
First Line	:	6410 ENTERPRISE LN STE 210
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1143
Country	:	US
Telephone Number	:	608-492-4352
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 ENTERPRISE LN STE 210
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1143
Country	:	US
Telephone Number	:	608-492-4352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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