Provider Demographics
NPI:1346588639
Name:WATTS, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CASTREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA SLP
Mailing Address - Street 1:13501 NE 28TH STREET
Mailing Address - Street 2:EVERGREEN PUBLIC SCHOOLS
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-604-6700
Mailing Address - Fax:
Practice Address - Street 1:14240 SE 132ND AVENUE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-604-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist