Provider Demographics
NPI:1114375003
Name:WATSON, DANIELLE KATHLYN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHLYN
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RAFF AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3223
Mailing Address - Country:US
Mailing Address - Phone:516-467-7900
Mailing Address - Fax:
Practice Address - Street 1:205 RAFF AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3223
Practice Address - Country:US
Practice Address - Phone:516-467-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist