Provider Demographics
NPI:1053853721
Name:DAVIS, CRISTY CATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTY
Middle Name:CATHERINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:CRISTY
Other - Middle Name:CATHERINE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:700 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3245
Mailing Address - Country:US
Mailing Address - Phone:814-765-7546
Mailing Address - Fax:
Practice Address - Street 1:700 LEONARD ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3245
Practice Address - Country:US
Practice Address - Phone:814-765-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist