Provider Demographics
NPI:1437674249
Name:WATTS, KELLY (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COUNTY ROAD 7290
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8121
Mailing Address - Country:US
Mailing Address - Phone:870-318-6529
Mailing Address - Fax:
Practice Address - Street 1:9546 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:LEXA
Practice Address - State:AR
Practice Address - Zip Code:72355-8424
Practice Address - Country:US
Practice Address - Phone:870-572-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant