Provider Demographics
NPI:1508034067
Name:DAVIS, ANTONILLA LUCINDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANTONILLA
Middle Name:LUCINDA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:PO BOX 720157
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0157
Mailing Address - Country:US
Mailing Address - Phone:956-682-6900
Mailing Address - Fax:956-682-8445
Practice Address - Street 1:1002 W SAM HOUSTON SUITE 10
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5198
Practice Address - Country:US
Practice Address - Phone:956-702-9882
Practice Address - Fax:956-702-9886
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2011-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX103926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist