Provider Demographics
NPI:1558501056
Name:DAVIDSON, KELLI G (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:G
Last Name:DAVIDSON
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Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:264 DAVIDSON CREEK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7916
Mailing Address - Country:US
Mailing Address - Phone:970-769-1661
Mailing Address - Fax:970-375-0056
Practice Address - Street 1:264 DAVIDSON CREEK RD
Practice Address - Street 2:SUITE B
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7916
Practice Address - Country:US
Practice Address - Phone:970-769-1661
Practice Address - Fax:970-375-0057
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist