Provider Demographics
NPI:1699559120
Name:WATSON, MAKAYLA ELANI (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MAKAYLA
Middle Name:ELANI
Last Name:WATSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:ELANI
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:464 2ND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2015
Mailing Address - Country:US
Mailing Address - Phone:952-401-4242
Mailing Address - Fax:
Practice Address - Street 1:464 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2015
Practice Address - Country:US
Practice Address - Phone:952-401-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist