Provider Demographics
NPI:1609010354
Name:DAVOLI, MEGAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:DAVOLI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 N CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9326
Mailing Address - Country:US
Mailing Address - Phone:904-209-6893
Mailing Address - Fax:
Practice Address - Street 1:4077 N CHINOOK LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9326
Practice Address - Country:US
Practice Address - Phone:904-209-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9922OtherSTATE LICENSE