Provider Demographics
NPI:1679751747
Name:WATTS, KIMBERLEE C (MA-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:C
Last Name:WATTS
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 13TH AVE
Mailing Address - Street 2:APT A
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3245
Mailing Address - Country:US
Mailing Address - Phone:304-523-0968
Mailing Address - Fax:
Practice Address - Street 1:2850 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1436
Practice Address - Country:US
Practice Address - Phone:304-528-5000
Practice Address - Fax:304-528-5080
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004510Medicaid