Provider Demographics
NPI:1316225584
Name:DAVIDSON, MARJORIE E (MA, CCC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:E
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3526
Mailing Address - Country:US
Mailing Address - Phone:908-304-9595
Mailing Address - Fax:
Practice Address - Street 1:1007 ROSEMARY DR
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3526
Practice Address - Country:US
Practice Address - Phone:908-304-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS02127235Z00000X
NY2208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist