Provider Demographics
NPI:1649592247
Name:WATKINS, BETSY (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W MONROE ST APT 614
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2557
Mailing Address - Country:US
Mailing Address - Phone:773-851-8643
Mailing Address - Fax:
Practice Address - Street 1:1200 W MONROE ST APT 614
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2557
Practice Address - Country:US
Practice Address - Phone:773-851-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist