Provider Demographics
NPI:1225042302
Name:DAVIS, REBECCA KAY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:KAY
Other - Last Name:DOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:403 WILDCREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223
Mailing Address - Country:US
Mailing Address - Phone:501-831-4327
Mailing Address - Fax:501-315-3467
Practice Address - Street 1:2700 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206
Practice Address - Country:US
Practice Address - Phone:507-447-6744
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T094OtherAR BCBS
AR127558721Medicaid