Provider Demographics
NPI:1679806061
Name:DAVIS, YOLANDA TREVINO (MA,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:TREVINO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BUSINESS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4499
Mailing Address - Country:US
Mailing Address - Phone:956-517-1235
Mailing Address - Fax:888-588-3234
Practice Address - Street 1:35 BUSINESS DR
Practice Address - Street 2:SUITE C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4499
Practice Address - Country:US
Practice Address - Phone:956-517-1235
Practice Address - Fax:888-588-3234
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0046NNOtherBLUE CROSS BLUE SHIELD
TX00994ZOtherMEDICARE PART B
TX0046NNOtherMEDICARE PART B
TX178709501Medicaid
676617OtherMEDICARE PART A