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General NPI Number Information
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NPI Number | 1427669662
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Entity Type | Individual
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Provider Name | LAURYN JOY WATERSON MA, CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 4610 25TH ST
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City | COLUMBUS
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State | IN
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Zip | 47203-3239
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Country | US
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Telephone | 812-314-2378
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Fax |
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Provider Business Mailing Address
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Address Line | 8801 CEDAR GROVE LN APT 628
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9813
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Country | US
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Telephone | 616-498-1155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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