Provider Demographics
NPI:1376221598
Name:WATSON, RANDI KRISANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:KRISANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2743
Mailing Address - Country:US
Mailing Address - Phone:281-338-5830
Mailing Address - Fax:
Practice Address - Street 1:2109 W MARYS CREEK LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-6021
Practice Address - Country:US
Practice Address - Phone:832-335-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist