Provider Demographics
NPI:1730253162
Name:WATERS, CHRIS THARRINGTON (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHRIS
Middle Name:THARRINGTON
Last Name:WATERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BAREFOOT CV
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HYPOLUXO
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6508
Mailing Address - Country:US
Mailing Address - Phone:850-339-3975
Mailing Address - Fax:
Practice Address - Street 1:132 BAREFOOT CV
Practice Address - Street 2:
Practice Address - City:HYPOLUXO
Practice Address - State:FL
Practice Address - Zip Code:33462-6508
Practice Address - Country:US
Practice Address - Phone:850-339-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-18
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886392000Medicaid