Provider Demographics
NPI:1508184482
Name:DAVIS, MARIA (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2910
Mailing Address - Country:US
Mailing Address - Phone:908-963-7172
Mailing Address - Fax:
Practice Address - Street 1:11 SPRUCE LN
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2910
Practice Address - Country:US
Practice Address - Phone:908-963-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
MESP2525235Z00000X
TX104999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESP2525OtherSPEECH LANGUAGE PATHOLOGY LICENSE