Individual
MRS. LORI J WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2030 CHILHOWEE MEDICAL PARK, MARYVILLE, TN 37804-5285
(865) 982-3400
(865) 982-3410
Mailing address
PO BOX 5209, MARYVILLE, TN 37802-5209
(865) 982-3400
(865) 982-3410
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
950
TN
235Z00000X
Speech-Language Pathologist
Primary
SLP005381
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00966237A
—
GA
01
—
10052515
AMERIGROUP
—
01
—
339902
WELLCARE
—
01
—
4094224
BCBS
TN
01
—
52887707001
BCBS
GA
Enumeration date
12/14/2006
Last updated
12/30/2009
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