Provider Demographics
NPI:1255481859
Name:WATSON, MALINDA RENEE (SLP)
Entity Type:Individual
Prefix:MS
First Name:MALINDA
Middle Name:RENEE
Last Name:WATSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 MANOR PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1648
Mailing Address - Country:US
Mailing Address - Phone:601-990-8839
Mailing Address - Fax:
Practice Address - Street 1:1830 MANOR PLACE DR
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1648
Practice Address - Country:US
Practice Address - Phone:662-209-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist