Provider Demographics
NPI:1114203882
Name:DAVENPORT, GINA R (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:R
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:DAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ZOLLER ELEMENTARY SCHOOL
Mailing Address - Street 2:1180 LANCASTER STREET
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308
Mailing Address - Country:US
Mailing Address - Phone:518-370-8290
Mailing Address - Fax:518-881-3882
Practice Address - Street 1:ZOLLER ELEMENTARY SCHOOL
Practice Address - Street 2:1180 LANCASTER STREET
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308
Practice Address - Country:US
Practice Address - Phone:518-370-8290
Practice Address - Fax:518-881-3882
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010862235Z00000X
NY010862-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist