Provider Demographics
NPI:1356880058
Name:WATERS, VANESSA LAUREN (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LAUREN
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 GREEN FOREST LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1918
Mailing Address - Country:US
Mailing Address - Phone:850-276-6946
Mailing Address - Fax:
Practice Address - Street 1:2890 GREEN FOREST LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1918
Practice Address - Country:US
Practice Address - Phone:850-276-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist