Individual
STACEY WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
3292 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 365-8920
(616) 365-8971
Mailing address
3292 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 365-8920
(616) 365-8971
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
146.013153
IL
235Z00000X
Speech-Language Pathologist
Primary
7101005811
MI
Other
Enumeration date
05/04/2015
Last updated
06/27/2018
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