Provider Demographics
NPI:1760636617
Name:WATTS, PATRICIA MARCELLE (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARCELLE
Last Name:WATTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3032
Mailing Address - Country:US
Mailing Address - Phone:315-786-7285
Mailing Address - Fax:315-786-7270
Practice Address - Street 1:1635 OHIO ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3032
Practice Address - Country:US
Practice Address - Phone:315-786-7285
Practice Address - Fax:315-786-7270
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012927-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist