Provider Demographics
NPI:1427669662
Name:WATERSON, LAURYN JOY (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:JOY
Last Name:WATERSON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 CEDAR GROVE LN APT 628
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9813
Mailing Address - Country:US
Mailing Address - Phone:616-498-1155
Mailing Address - Fax:
Practice Address - Street 1:4610 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3239
Practice Address - Country:US
Practice Address - Phone:812-314-2378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist