Provider Demographics
NPI:1073180634
Name:WATSON SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:WATSON SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:508-237-6643
Mailing Address - Street 1:4 DUNDEE CIR
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-3389
Mailing Address - Country:US
Mailing Address - Phone:508-237-6643
Mailing Address - Fax:857-557-5430
Practice Address - Street 1:4 DUNDEE CIR
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-3389
Practice Address - Country:US
Practice Address - Phone:508-237-6643
Practice Address - Fax:857-557-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12007149OtherASHA LICENSE
MA4469OtherMASSACHUSETTS SLP LICENSE