Provider Demographics
NPI:1023170487
Name:WATSON, LORI J (SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:J
Last Name:WATSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5209
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5209
Mailing Address - Country:US
Mailing Address - Phone:865-982-3400
Mailing Address - Fax:865-982-3410
Practice Address - Street 1:2030 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-982-3400
Practice Address - Fax:865-982-3410
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005381235Z00000X
TN950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4094224OtherBCBS
GA52887707001OtherBCBS
10052515OtherAMERIGROUP
GA00966237AMedicaid
339902OtherWELLCARE