Provider Demographics
NPI:1124726302
Name:WATSON, TENAYA
Entity type:Individual
Prefix:
First Name:TENAYA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 E TROPICANA AVE STE 199
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6564
Mailing Address - Country:US
Mailing Address - Phone:702-408-7123
Mailing Address - Fax:
Practice Address - Street 1:2875 SAINT ROSE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4842
Practice Address - Country:US
Practice Address - Phone:800-966-0535
Practice Address - Fax:800-966-1135
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3406261QH0700X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech