Provider Demographics
NPI:1225051451
Name:DAVIS, BRENDA PERRY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:PERRY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MARKET ST
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4055
Mailing Address - Country:US
Mailing Address - Phone:512-789-3398
Mailing Address - Fax:512-857-1479
Practice Address - Street 1:600 MARKET ST
Practice Address - Street 2:SUITE G-2
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4055
Practice Address - Country:US
Practice Address - Phone:512-789-3398
Practice Address - Fax:512-857-1479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2009326Medicaid