Provider Demographics
NPI:1548018658
Name:WELCH, KODEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KODEE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KODEE
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2213 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-7156
Mailing Address - Country:US
Mailing Address - Phone:406-871-1930
Mailing Address - Fax:
Practice Address - Street 1:10245 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3341
Practice Address - Country:US
Practice Address - Phone:330-748-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist