Provider Demographics
NPI:1457457244
Name:DAVISON, JUDY (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BLALOCK RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6443
Mailing Address - Country:US
Mailing Address - Phone:713-468-0300
Mailing Address - Fax:
Practice Address - Street 1:1240 BLALOCK RD
Practice Address - Street 2:SUITE 170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6443
Practice Address - Country:US
Practice Address - Phone:713-468-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist