Healthcare Provider Details

I. General information

NPI: 1922931120
Provider Name (Legal Business Name): THERESA M WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 KINGSTON DR
CHERRY HILL NJ
08034-1833
US

IV. Provider business mailing address

813 KINGSTON DR
CHERRY HILL NJ
08034-1833
US

V. Phone/Fax

Practice location:
  • Phone: 215-820-3689
  • Fax:
Mailing address:
  • Phone: 215-820-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberW08537397452762
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: