Provider Demographics
NPI:1164849378
Name:DAVIS, RICHARD BRIAN (CCCSLP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRIAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5201
Mailing Address - Country:US
Mailing Address - Phone:714-305-1661
Mailing Address - Fax:
Practice Address - Street 1:756 S WOODLAND ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-5201
Practice Address - Country:US
Practice Address - Phone:714-305-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist