Lauren Watters, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6403-154 Issued in WI

Practice address

630 S 36TH Ave
Wausau, WI 54401-3930

Phone

(855) 607-8242

NPI assigned

Jul 12, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Health Clinic, LLC

  • Clinical Psychologist
  • Wausau, WI
  • NPI 1831442359

  Speech-Language Pathologist, WI

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1053045484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 S 36TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 S 36TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013930",
            "telephone_number": "855-607-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTERS",
        "first_name": "LAUREN",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "6403-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Wausau, WI
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.