Welby Joseph Lo, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Sonora, CA
NPI 1104299700 · NPPES record last updated Jan 23, 2021
Key facts
- NPI
- 1104299700
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 25209 (CA)
- Practice address
- 900 Mono Way
Sports Medicine and Rehabilitation
Sonora, CA 95370 - Phone
- (209) 536-6920
- NPI assigned
- Nov 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25209 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beyond Speech Therapy Inc | Speech-Language Pathologist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 10300 | CA | |
| Speech-Language Pathologist | 235Z00000X | 25209 | CA | Yes |
Addresses
Primary practice location
900 Mono Way
Sports Medicine and Rehabilitation
Sonora, CA 95370
Mailing address
900 Mono Way
Sports Medicine and Rehabilitation
Sonora, CA 95370
Phone (209) 536-6920
Other practice location 1
225 Posada Ln
Templeton, CA 93465-4058
Phone (805) 591-7188
Other providers in Sonora, CA
- Alan Levine
- Jayme Lynn Lewallen
- Justin Liggett
- Jamie D Lloyd
- Andrew Yung Lo
- Brett C. Lockman
- Nichole Terese Longeway
- Longs Drug Stores California LLC
- Louis Arlen Looper
- Danett L Lozano
All providers in Sonora, CA · Speech-Language Pathologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.