Provider Demographics
NPI:1942494190
Name:WATSON, DEAMI FAIDA (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:DEAMI
Middle Name:FAIDA
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 BAMBERGER AVE.
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4733
Mailing Address - Country:US
Mailing Address - Phone:314-633-5354
Mailing Address - Fax:
Practice Address - Street 1:801 N 11TH STREET
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101
Practice Address - Country:US
Practice Address - Phone:314-633-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist