Provider Demographics
NPI:1568637452
Name:DAVILA, JANET L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:DAVILA
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:12221 N MO PAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4006
Mailing Address - Fax:512-901-3906
Practice Address - Street 1:12221 N MO PAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4006
Practice Address - Fax:512-901-3906
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80030231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192842601Medicaid
TXP01292698OtherRRMC PTAN
TX192842602Medicaid
TX192842601Medicaid
TX8K6760Medicare PIN