Provider Demographics
NPI:1619267390
Name:DAVIS, PAMELA (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15164 WETHERBURN DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3926
Mailing Address - Country:US
Mailing Address - Phone:770-310-7995
Mailing Address - Fax:
Practice Address - Street 1:801 BUCHANAN ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3924
Practice Address - Country:US
Practice Address - Phone:292-281-2769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist