Provider Demographics
NPI:1265404529
Name:NINA WELCH SPEECH PATHOLOGY INC.
Entity type:Organization
Organization Name:NINA WELCH SPEECH PATHOLOGY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA MED, CCC, BCBA
Authorized Official - Phone:714-962-6760
Mailing Address - Street 1:18700 BEACH BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-962-6760
Mailing Address - Fax:714-962-5961
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:STE 120
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-962-6760
Practice Address - Fax:714-962-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096392103K00000X
CA4303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty