Provider Demographics
NPI:1215453964
Name:WATSON, COLEEN KAY
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:KAY
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 1:751 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445-1320
Mailing Address - Country:US
Mailing Address - Phone:660-727-3318
Mailing Address - Fax:
Practice Address - Street 1:751 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445-1320
Practice Address - Country:US
Practice Address - Phone:660-727-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist