Provider Demographics
NPI:1477004141
Name:WATSON, MICHAEL LYON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYON
Last Name:WATSON
Suffix:
Gender:M
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 1:2095 SW PUTNAM DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5841
Mailing Address - Country:US
Mailing Address - Phone:360-969-1628
Mailing Address - Fax:
Practice Address - Street 1:330 E CRESCENT HARBOR RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-9142
Practice Address - Country:US
Practice Address - Phone:360-279-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist