Provider Demographics
NPI:1114290509
Name:DAVIS, BASIL ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:ASHLEY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 OLD ERIE PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST DECATUR
Mailing Address - State:PA
Mailing Address - Zip Code:16878-8739
Mailing Address - Country:US
Mailing Address - Phone:814-765-4201
Mailing Address - Fax:
Practice Address - Street 1:383 ROLLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7679
Practice Address - Country:US
Practice Address - Phone:814-689-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist