Provider Demographics
NPI:1609110162
Name:WATTS, KERI (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11625 GEORGETOWNE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5681 BENTGRASS DR
Practice Address - Street 2:#104
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-7639
Practice Address - Country:US
Practice Address - Phone:888-592-2378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist