Provider Demographics
NPI:1700547668
Name:WATTS, CRYSTAL ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNE
Last Name:WATTS
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 1:717 NEELY RD
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3958
Mailing Address - Country:US
Mailing Address - Phone:267-401-0733
Mailing Address - Fax:
Practice Address - Street 1:717 NEELY RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3958
Practice Address - Country:US
Practice Address - Phone:267-401-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist