Provider Demographics
NPI:1053090548
Name:WELTON, STEVEN DEWEY
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DEWEY
Last Name:WELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2421
Mailing Address - Country:US
Mailing Address - Phone:224-398-6385
Mailing Address - Fax:
Practice Address - Street 1:120 N ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2421
Practice Address - Country:US
Practice Address - Phone:224-398-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional