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Individual
STACEY D WATSON
Active
Individual
STACEY D WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
LD 00002570
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039572
LABOR AND INDUSTRIES#
WA
01
—
4477WA
BLUE SHIELD#
WA
01
—
640004238
RAILROAD MC#
WA
05
—
8368235
—
WA
01
—
US2498706
AETNA SPECIALIST PIN
WA
Enumeration date
02/02/2007
Last updated
04/28/2021
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