Basic Information
Provider Information
NPI: 1679953152
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELCHER
FirstName: RACHEL
MiddleName: BURGER
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BURGER
OtherFirstName: RACHEL
OtherMiddleName: LOUISE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 90 HOWARD DR
Address2: APT 203
City: SHELBYVILLE
State: KY
PostalCode: 400658138
CountryCode: US
TelephoneNumber: 5026331007
FaxNumber: 5028051511
Practice Location
Address1: 90 HOWARD DR
Address2:  
City: SHELBYVILLE
State: KY
PostalCode: 400658138
CountryCode: US
TelephoneNumber: 5026331007
FaxNumber: 5028051511
Other Information
ProviderEnumerationDate: 06/01/2015
LastUpdateDate: 03/30/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X  Y Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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