Healthcare Provider Details

I. General information

NPI: 1518960723
Provider Name (Legal Business Name): T LANETTE WATSON MA CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OCHSNER BLVD
COVINGTON LA
70433-8107
US

IV. Provider business mailing address

1000 OCHSNER BLVD
COVINGTON LA
70433-8107
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-2828
  • Fax: 985-875-2721
Mailing address:
  • Phone: 985-875-2828
  • Fax: 985-875-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4651
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number4651
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number4651
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4651
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: