Provider Demographics
NPI:1235457227
Name:DAVIS, CARIE JANELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARIE
Middle Name:JANELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:CARIE
Other - Middle Name:JANELLE
Other - Last Name:ELLIOTT-DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9 LACRUE AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CONCORDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19331
Mailing Address - Country:US
Mailing Address - Phone:800-878-5497
Mailing Address - Fax:
Practice Address - Street 1:9 LACRUE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1062
Practice Address - Country:US
Practice Address - Phone:800-578-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN317212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist