Provider Demographics
NPI:1245427277
Name:WATSON, MADISON MAE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:MAE
Last Name:WATSON
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 1:1005 SPRINGHILL DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1748
Mailing Address - Country:US
Mailing Address - Phone:541-967-4518
Mailing Address - Fax:
Practice Address - Street 1:1005 SPRINGHILL DR NE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1748
Practice Address - Country:US
Practice Address - Phone:541-967-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist