Provider Demographics
NPI:1760157630
Name:DAVIS, VICTORIA L (CCC- SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:DAVIS
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 1:320 W PIKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4866
Mailing Address - Country:US
Mailing Address - Phone:678-278-9244
Mailing Address - Fax:678-412-1679
Practice Address - Street 1:320 W PIKE ST STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4866
Practice Address - Country:US
Practice Address - Phone:678-278-9244
Practice Address - Fax:678-412-1679
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP14345235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist