Provider Demographics
NPI:1124785050
Name:WATTS, MCKENNA (CSW)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W 710 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-8824
Mailing Address - Country:US
Mailing Address - Phone:801-663-1776
Mailing Address - Fax:
Practice Address - Street 1:394 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2035
Practice Address - Country:US
Practice Address - Phone:801-709-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program