Provider Demographics
NPI:1073758942
Name:DAVIS, KATHLEEN ANNE (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 NAHATAN ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1445
Mailing Address - Country:US
Mailing Address - Phone:781-762-1080
Mailing Address - Fax:781-762-3122
Practice Address - Street 1:89 ACCESS RD
Practice Address - Street 2:SUITE 28
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5229
Practice Address - Country:US
Practice Address - Phone:617-823-9079
Practice Address - Fax:781-762-3122
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469002OtherTUFTS HEALTH CARE
MA0377856Medicaid
MASP0087OtherBLUE CROSS BLUE SHIELD
MA626560OtherHARVARD PILGRIM HEALTHCARE