Provider Demographics
NPI:1205986064
Name:WATSON, ALTHEA G (MAUD)
Entity type:Individual
Prefix:MS
First Name:ALTHEA
Middle Name:G
Last Name:WATSON
Suffix:
Gender:F
Credentials:MAUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BIG LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9182
Mailing Address - Country:US
Mailing Address - Phone:803-736-5756
Mailing Address - Fax:
Practice Address - Street 1:104 BIG LEAF CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9182
Practice Address - Country:US
Practice Address - Phone:803-736-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC515231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist