Provider Demographics
NPI:1407107998
Name:DAVIS, KRISTIE LYNN (MS SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2973
Mailing Address - Country:US
Mailing Address - Phone:928-502-4399
Mailing Address - Fax:928-502-4444
Practice Address - Street 1:450 W 6TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2973
Practice Address - Country:US
Practice Address - Phone:928-502-4399
Practice Address - Fax:928-502-4444
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP8000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist