Healthcare Provider Details

I. General information

NPI: 1891036034
Provider Name (Legal Business Name): HOLLY MICHELLE WATSON MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY MICHELLE WATSON SLP, MFT

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 AMES ST
BALDWIN CITY KS
66006-3072
US

IV. Provider business mailing address

1100 TENNESSEE ST APT 4
LAWRENCE KS
66044-6013
US

V. Phone/Fax

Practice location:
  • Phone: 913-396-1903
  • Fax:
Mailing address:
  • Phone: 913-396-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03763
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3360
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: