Provider Demographics
NPI:1841705316
Name:WATTS, TAMRA ANITA (SLP)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:ANITA
Last Name:WATTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232-1525
Mailing Address - Country:US
Mailing Address - Phone:618-346-6205
Mailing Address - Fax:
Practice Address - Street 1:433 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1525
Practice Address - Country:US
Practice Address - Phone:618-346-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist