Provider Demographics
NPI:1821280041
Name:WATSON, JENNIFER (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 INKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1707
Mailing Address - Country:US
Mailing Address - Phone:508-237-6643
Mailing Address - Fax:
Practice Address - Street 1:8 INKBERRY LN
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1707
Practice Address - Country:US
Practice Address - Phone:508-237-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist