Provider Demographics
NPI:1790038867
Name:DAVIS, IDA JANE (SLP)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:JANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 SANTA FE DR
Mailing Address - Street 2:SUITE #303
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3655
Mailing Address - Country:US
Mailing Address - Phone:913-631-9471
Mailing Address - Fax:
Practice Address - Street 1:8826 SANTA FE DR
Practice Address - Street 2:SUITE #303
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3655
Practice Address - Country:US
Practice Address - Phone:913-631-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist