Provider Demographics
NPI:1336397413
Name:WATSON, SUSAN ANN (RCR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:RCR
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCR
Mailing Address - Street 1:2020 HILLSDOWN RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61019-9411
Mailing Address - Country:US
Mailing Address - Phone:815-986-8308
Mailing Address - Fax:
Practice Address - Street 1:2020 HILLSDOWN RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:IL
Practice Address - Zip Code:61019-9411
Practice Address - Country:US
Practice Address - Phone:815-986-8308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist