Provider Demographics
NPI:1194042739
Name:WATKINS, LA CHELLE GARDNER (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LA CHELLE
Middle Name:GARDNER
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 PINELLI DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2262
Mailing Address - Country:US
Mailing Address - Phone:240-441-1908
Mailing Address - Fax:732-422-0133
Practice Address - Street 1:258 PINELLI DR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-2262
Practice Address - Country:US
Practice Address - Phone:240-441-1908
Practice Address - Fax:732-422-0133
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00476100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist