Provider Demographics
NPI:1033410865
Name:DAVIS-COTTRELL, CHRISTY (MA CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:
Last Name:DAVIS-COTTRELL
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 1:2500 POLO RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3950
Mailing Address - Country:US
Mailing Address - Phone:336-734-1734
Mailing Address - Fax:
Practice Address - Street 1:2500 POLO RIDGE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3950
Practice Address - Country:US
Practice Address - Phone:336-734-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist