Provider Demographics
NPI:1548589369
Name:DAVIS, ANA LAURA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LAURA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:LAURA
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:711 LARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3002
Mailing Address - Country:US
Mailing Address - Phone:956-220-1329
Mailing Address - Fax:
Practice Address - Street 1:7800 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2509
Practice Address - Country:US
Practice Address - Phone:210-832-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1714362-01Medicaid
TX1714362-01Medicaid