Provider Demographics
NPI:1093010555
Name:DAVIS, HAYDEN TAYLOR (MS CCCSLP)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:TAYLOR
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 SOUNDPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3581
Mailing Address - Country:US
Mailing Address - Phone:850-232-4886
Mailing Address - Fax:
Practice Address - Street 1:8740 ORTEGA PARK DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4139
Practice Address - Country:US
Practice Address - Phone:850-939-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist