Provider Demographics
NPI:1154314359
Name:WATTS, MICHELE L (MS, CCC-A, FAAA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:WATTS
Suffix:
Gender:F
Credentials:MS, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:219-364-3610
Practice Address - Street 1:2802 LEONARD DRIVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-531-0355
Practice Address - Fax:219-531-2855
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002040A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000195574OtherANTHEM
IN200339220Medicaid
IN000000195574OtherANTHEM
IN640004184Medicare ID - Type UnspecifiedRAILROAD MEDICARE