Provider Demographics
NPI:1518244185
Name:WATSON, DENISE (SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
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 1:210A SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1758
Mailing Address - Country:US
Mailing Address - Phone:516-308-5500
Mailing Address - Fax:
Practice Address - Street 1:210A SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1758
Practice Address - Country:US
Practice Address - Phone:516-308-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY58-014234Medicaid