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Individual

JEANNETTE L. WATERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S., CCC-SLP

Contact information

Practice address
2148 SAGECREST LOOP NE, RIO RANCHO, NM 87144-2856
(505) 463-8195
Mailing address
2148 SAGECREST LOOP NE, RIO RANCHO, NM 87144-2856
(505) 463-8195

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
289
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01030680
AMERICAN SPEECH, LANGUAGE, HEARING CERTIFICATION NUMBER
NM
01
289
NEW MEXICO STATE LICENSURE FOR SPEECH PATHOLOGY
NM
Enumeration date
09/18/2012
Last updated
09/18/2012
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