Provider Demographics
NPI:1255586327
Name:WATSON, AMANDA (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TULLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 LOSEE RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4450
Mailing Address - Country:US
Mailing Address - Phone:845-505-6236
Mailing Address - Fax:
Practice Address - Street 1:27 LOSEE RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4450
Practice Address - Country:US
Practice Address - Phone:845-505-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017961-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist