Provider Demographics
NPI:1982259925
Name:WATSON, MOLLIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:BLAHAUSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2830 G ST STE C1
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2830 G ST STE C1
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4447
Practice Address - Country:US
Practice Address - Phone:707-440-9356
Practice Address - Fax:707-362-8428
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2546235Z00000X
235Z00000X
CA32528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist