Provider Demographics
NPI:1760034615
Name:WATERS, ALLISON WEAVER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:WEAVER
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2006 CHARLION DOWNS LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6451
Mailing Address - Country:US
Mailing Address - Phone:919-819-2925
Mailing Address - Fax:
Practice Address - Street 1:140 CABARRUS AVE W
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5150
Practice Address - Country:US
Practice Address - Phone:919-819-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty