Provider Demographics
NPI:1528375870
Name:WATSON, RUDYARD CRAIG-ANTHONY (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MR
First Name:RUDYARD
Middle Name:CRAIG-ANTHONY
Last Name:WATSON
Suffix:
Gender:M
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 AVENUE Z
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6181
Mailing Address - Country:US
Mailing Address - Phone:917-533-7841
Mailing Address - Fax:718-332-4794
Practice Address - Street 1:577 AVENUE Z
Practice Address - Street 2:SUITE 5D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6181
Practice Address - Country:US
Practice Address - Phone:917-533-7841
Practice Address - Fax:718-332-4794
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist