Healthcare Provider Details

I. General information

NPI: 1356265953
Provider Name (Legal Business Name): ISABEL ANN WATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

12110 CLAYTON RD
SAINT LOUIS MO
63131-2599
US

IV. Provider business mailing address

4154 MCREE AVE APT 2E
SAINT LOUIS MO
63110-2482
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-8100
  • Fax:
Mailing address:
  • Phone: 314-304-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026032867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: