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NPI Code Detail

MEDICARE: ANGELA MARIE WATTERS M.S., CCC-SLP

MEDICARE: ANGELA MARIE WATTERS M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSA11936FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619239894
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MARIE WATTERS M.S., CCC-SLP
Provider Business Mailing Address
First Line : 2122 TROY RD STE 120
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-2540
Country : US
Telephone Number : 618-800-4620
Fax Number :
Provider Business Practice Location Address
First Line : 2122 TROY RD STE 120
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-2540
Country : US
Telephone Number : 618-800-4620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2012
Last Update Date : 04/24/2023

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Directions to “ ANGELA MARIE WATTERS M.S., CCC-SLP” Practice Location

Language Start Address Practice Location
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