Provider Demographics
NPI:1336349505
Name:WATSON, SHELLEY DENISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:DENISE
Last Name:WATSON
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 1:1180 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2115
Mailing Address - Country:US
Mailing Address - Phone:541-337-4798
Mailing Address - Fax:
Practice Address - Street 1:1180 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2115
Practice Address - Country:US
Practice Address - Phone:541-337-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2007049000111170904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist