Provider Demographics
NPI:1841380987
Name:DAVIDSON, ANNE DEVINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:DEVINE
Last Name:DAVIDSON
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 1:6 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1016
Mailing Address - Country:US
Mailing Address - Phone:815-754-4058
Mailing Address - Fax:815-753-1664
Practice Address - Street 1:1 LUCINDA AVE
Practice Address - Street 2:NORTHERN ILLINOIS UNIV. SPEECH-LANGUAGE-HEARING CLINIC
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2899
Practice Address - Country:US
Practice Address - Phone:815-753-1483
Practice Address - Fax:815-753-1664
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist