Basic Information
| Provider Information | |||||||||
| NPI: | 1336779768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | ERYNN | ||||||||
| MiddleName: | PATEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14244 WILLOW BEND PARK APT 6 | ||||||||
| Address2: | |||||||||
| City: | TOWN AND COUNTRY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630178247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6609731695 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12110 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149898100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2020 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP12251 | AZ | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 2022035199 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SLP12251 | 01 | AZ | STATE LICENSE | OTHER |