Provider Demographics
NPI:1932101300
Name:DAVIDSON, LISA H (AUD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1503
Mailing Address - Country:US
Mailing Address - Phone:931-473-3833
Mailing Address - Fax:
Practice Address - Street 1:904 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1503
Practice Address - Country:US
Practice Address - Phone:931-473-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN185231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3192384Medicaid
TN3075665OtherBLUE CROSS
TN3075665OtherTN CARE SELECT
4186249OtherBCBS OF TENNESSEE
TN3075665OtherBLUE CROSS
TN3075665OtherTN CARE SELECT