Provider Demographics
NPI:1023158656
Name:WATERS, NANCY KAY (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:KAY
Last Name:WATERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MANASSAS PL
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6828
Mailing Address - Country:US
Mailing Address - Phone:573-230-3855
Mailing Address - Fax:
Practice Address - Street 1:906 MANASSAS PL
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6828
Practice Address - Country:US
Practice Address - Phone:573-230-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00809235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist