Provider Demographics
NPI:1972531770
Name:DAVIS, JULIE ANN (MA CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:810-664-1141
Mailing Address - Fax:810-664-1523
Practice Address - Street 1:286 W NEPESSING ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2194
Practice Address - Country:US
Practice Address - Phone:810-664-1141
Practice Address - Fax:810-664-1523
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000059231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1972531770Medicaid
MIN71660010Medicare PIN