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General NPI Number Information
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NPI Number | 1891022927
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Entity Type | Individual
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Provider Name | SHANNON WATTS M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 169 TEQUESTA DR SUITE 24E
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City | TEQUESTA
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State | FL
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Zip | 33469-2768
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Country | US
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Telephone | 772-215-3335
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Fax | 772-287-0723
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Provider Business Mailing Address
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Address Line | 169 TEQUESTA DR SUITE 24E
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City | TEQUESTA
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State | FL
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Zip | 33469-2768
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Country | US
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Telephone | 772-215-3335
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Fax | 772-287-0723
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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 | SA10134
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License Number State | FL
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