Provider Demographics
NPI:1114496189
Name:WATSON, STEFANI DIANNE (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:DIANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 E 1060 S
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6271
Mailing Address - Country:US
Mailing Address - Phone:435-313-1857
Mailing Address - Fax:
Practice Address - Street 1:299 E 1060 S
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6271
Practice Address - Country:US
Practice Address - Phone:435-313-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5725579-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist