MEDICARE: KAYLA WELCH BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750017984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA WELCH BCBA

Provider Business Mailing Address
First Line	:	2218 ELMA RD
Second Line	:
City	:	HOMER
State	:	NE
Zip	:	68030-3018
Country	:	US
Telephone Number	:	712-899-2167
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 HAMILTON BLVD STE D
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-4142
Country	:	US
Telephone Number	:	712-746-7447
Fax Number	:

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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