Individual
MICAELA WATMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20402 N 15TH AVE, PHOENIX, AZ 85027-3636
(623) 445-5000
Mailing address
1100 E OSBORN RD APT 240, PHOENIX, AZ 85014-5268
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
12454
AZ
235Z00000X
Speech-Language Pathologist
Primary
TSLP16525
AZ
Other
Enumeration date
07/10/2020
Last updated
04/06/2026
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