Provider Demographics
NPI:1699907121
Name:WATERS, ALLYSON KIPP (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:KIPP
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SANDERLING DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-8254
Mailing Address - Country:US
Mailing Address - Phone:863-662-4690
Mailing Address - Fax:
Practice Address - Street 1:105 SANDERLING DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-8254
Practice Address - Country:US
Practice Address - Phone:863-298-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist