Provider Demographics
NPI:1891209094
Name:DAVIS SPEECH AND LANGUAGE SERVICES, LLC
Entity Type:Organization
Organization Name:DAVIS SPEECH AND LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RODNEISHA
Authorized Official - Middle Name:CHANELLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:628-233-2311
Mailing Address - Street 1:10482 BALTIMORE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2321
Mailing Address - Country:US
Mailing Address - Phone:628-233-2311
Mailing Address - Fax:
Practice Address - Street 1:10482 BALTIMORE AVE STE 215
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2321
Practice Address - Country:US
Practice Address - Phone:628-233-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08247261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech