Individual
MRS. KELLIE P WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP
Contact information
Practice address
420 PAT RD, LEXINGTON, SC 29073-8435
(803) 767-5153
(803) 955-0972
Mailing address
1488 OLD 96 INDIAN TRL, BATESBURG, SC 29006-9602
(803) 685-6225
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3812
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12028242
NATIONAL LICENSE
SC
01
—
3812
STATE LICENSE
SC
Enumeration date
05/21/2007
Last updated
07/08/2007
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