Provider Demographics
NPI:1467992537
Name:DAVIS, AMBER KRISTINE (MA CF-SLP/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KRISTINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA CF-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W PARK
Mailing Address - Street 2:PRESENCE HEALTH MEDICAL CENTER
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-337-2109
Mailing Address - Fax:
Practice Address - Street 1:1400 W. PARK
Practice Address - Street 2:PRESENCE HEALTH MEDICAL CENTER
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-337-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14129268235Z00000X
IL242.004185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist