Provider Demographics
NPI:1184362824
Name:WATSON, MADISON EMMA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:EMMA
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 1:36 THRUMONT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7720
Mailing Address - Country:US
Mailing Address - Phone:973-590-1298
Mailing Address - Fax:
Practice Address - Street 1:36 THRUMONT RD
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7720
Practice Address - Country:US
Practice Address - Phone:973-590-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01106700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist