Provider Demographics
NPI:1760136667
Name:DAVIS, KATHARINA LARA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINA
Middle Name:LARA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KATHARINA
Other - Middle Name:LARA
Other - Last Name:BERTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7788 S ESTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5002
Mailing Address - Country:US
Mailing Address - Phone:248-214-0983
Mailing Address - Fax:
Practice Address - Street 1:7788 S ESTON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5002
Practice Address - Country:US
Practice Address - Phone:248-214-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007669235Z00000X
WALL61219960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist