Provider Demographics
NPI:1396795613
Name:WATSON, PATTI RAE (EDD)
Entity type:Individual
Prefix:DR
First Name:PATTI
Middle Name:RAE
Last Name:WATSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W CALLE LAGO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3914
Mailing Address - Country:US
Mailing Address - Phone:520-229-2012
Mailing Address - Fax:520-288-8222
Practice Address - Street 1:454 W CALLE LAGO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3914
Practice Address - Country:US
Practice Address - Phone:520-229-2012
Practice Address - Fax:520-288-8222
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3298103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ116489OtherMEDICARE PTAN