Individual
MARY B WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1910 SOUTH AVE, LA CROSSE, WI 54601-5467
(608) 775-2287
Mailing address
1910 SOUTH AVE, LA CROSSE, WI 54601-5467
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3890
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39777200
—
WI
Enumeration date
06/23/2005
Last updated
07/08/2007
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