Provider Demographics
NPI:1578061123
Name:WATSON, AMY LYNN MARTINEZ
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN MARTINEZ
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 COUNTRY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-9338
Mailing Address - Country:US
Mailing Address - Phone:361-658-4799
Mailing Address - Fax:
Practice Address - Street 1:8505 CROSS PARK DR STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4552
Practice Address - Country:US
Practice Address - Phone:361-658-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist