Provider Demographics
NPI:1679521199
Name:WATSON, PHYLLIS S (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:S
Last Name:WATSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 COMMUNICATION DR
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-1440
Mailing Address - Country:US
Mailing Address - Phone:603-528-3060
Mailing Address - Fax:603-524-0702
Practice Address - Street 1:67 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1440
Practice Address - Country:US
Practice Address - Phone:603-528-3060
Practice Address - Fax:603-524-0702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1307426Y0NH01OtherANTHEM BC/BS
31153YMedicare UPIN