Provider Demographics
NPI:1790114817
Name:WATTS, WENDY A
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3622
Mailing Address - Country:US
Mailing Address - Phone:865-463-2800
Mailing Address - Fax:865-457-6815
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:SUITE 506
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3622
Practice Address - Country:US
Practice Address - Phone:865-463-2800
Practice Address - Fax:865-457-6815
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist