Healthcare Provider Details

I. General information

NPI: 1982259925
Provider Name (Legal Business Name): MOLLIE WATSON MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLIE BLAHAUSZ

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 JANES RD STE 11
ARCATA CA
95521-4745
US

IV. Provider business mailing address

3798 JANES RD STE 11
ARCATA CA
95521-4745
US

V. Phone/Fax

Practice location:
  • Phone: 707-440-9356
  • Fax: 707-362-8428
Mailing address:
  • Phone: 707-440-9356
  • Fax: 707-362-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-2546
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: