Provider Demographics
NPI:1881848968
Name:WATSON, ANDRIETTE D (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDRIETTE
Middle Name:D
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 1:13521 NICHOLS DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1326
Mailing Address - Country:US
Mailing Address - Phone:443-604-2509
Mailing Address - Fax:301-854-0037
Practice Address - Street 1:13521 NICHOLS DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1326
Practice Address - Country:US
Practice Address - Phone:443-604-2509
Practice Address - Fax:301-854-0037
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD662877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist