Healthcare Provider Details

I. General information

NPI: 1962525725
Provider Name (Legal Business Name): JULIE L. WATSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BARKER RD
HENDERSON KY
42420-2305
US

IV. Provider business mailing address

211 BARKER RD
HENDERSON KY
42420-2305
US

V. Phone/Fax

Practice location:
  • Phone: 812-453-2452
  • Fax: 270-831-1875
Mailing address:
  • Phone: 812-453-2452
  • Fax: 270-831-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22000028A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number282N00000X
License Number StateIN

VIII. Authorized Official

Name: MRS. JULIE L WATSON
Title or Position: SPEECH PATHOLOGIST
Credential: M.A.-SLP
Phone: 812-453-2452