Provider Demographics
NPI:1023537198
Name:DAVIS, KATHRYN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PUBLIC SQ
Mailing Address - Street 2:2
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1436
Mailing Address - Country:US
Mailing Address - Phone:253-353-4622
Mailing Address - Fax:
Practice Address - Street 1:34 PUBLIC SQ
Practice Address - Street 2:2
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1436
Practice Address - Country:US
Practice Address - Phone:253-353-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist