Provider Demographics
NPI:1609394550
Name:WATSON, ROBERT FISCHER
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FISCHER
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6717
Mailing Address - Country:US
Mailing Address - Phone:225-241-1577
Mailing Address - Fax:
Practice Address - Street 1:2230 N FORT VALLEY RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1232
Practice Address - Country:US
Practice Address - Phone:928-773-4020
Practice Address - Fax:928-773-4020
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA108312355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty