Provider Demographics
NPI:1861159527
Name:WATSON, DENECIA DODSON
Entity type:Individual
Prefix:
First Name:DENECIA
Middle Name:DODSON
Last Name:WATSON
Suffix:
Gender:F
Credentials:
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 1831
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-1831
Mailing Address - Country:US
Mailing Address - Phone:936-635-3077
Mailing Address - Fax:
Practice Address - Street 1:303 W KNOX ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3966
Practice Address - Country:US
Practice Address - Phone:972-872-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104270225X00000X
TX12683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01027003OtherCERTIFICATE OF CLINICAL COMPETENCY - CCC-SLP
TX12683OtherSTATE LICENSE NUMBER