Provider Demographics
NPI:1790091726
Name:WATTERS, BRIGITTE CORINNE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:CORINNE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:BRIGITTE
Other - Middle Name:CORINNE
Other - Last Name:BORCUTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 15TH AVE SO
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-455-5902
Mailing Address - Fax:406-455-4147
Practice Address - Street 1:509 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2422
Practice Address - Country:US
Practice Address - Phone:309-452-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2363235Z00000X
IL146.015124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist