Provider Demographics
NPI:1427569474
Name:DAVIS, ROANNA LYNN (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ROANNA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5575
Mailing Address - Country:US
Mailing Address - Phone:303-462-6648
Mailing Address - Fax:
Practice Address - Street 1:11177 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5575
Practice Address - Country:US
Practice Address - Phone:303-462-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01111214OtherASHA
COSLP-0000280OtherDORA