Provider Demographics
NPI:1598459604
Name:WATSON, CELESTE JOI (AUD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:JOI
Last Name:WATSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:JOI
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1044 CROSS WOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6604
Mailing Address - Country:US
Mailing Address - Phone:870-329-1228
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202219231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist