MEDICARE: GENESIA T WATTERS

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
1	235Z00000X	Speech-Language Pathologist	2202012438	VA
2	235Z00000X	Speech-Language Pathologist	SLP101263	MA

General Provider Information

NPI Number	:	1811542921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENESIA T WATTERS

Provider Business Mailing Address
First Line	:	21600 OXNARD ST STE 1800
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7807
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	21800 OXNARD ST STE 1800
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3633
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	06/11/2026

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Directions to “ GENESIA T WATTERS ” Practice Location

Language	Start Address	Practice Location

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