Provider Demographics
NPI:1134215874
Name:DAVISON, LINDA L (MA CCCA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:DAVISON
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SPRING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8538
Mailing Address - Country:US
Mailing Address - Phone:740-695-1058
Mailing Address - Fax:740-695-1058
Practice Address - Street 1:205 SPRING PARK AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8538
Practice Address - Country:US
Practice Address - Phone:740-695-1058
Practice Address - Fax:740-695-0889
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005973231H00000X
WVA0056231H00000X
OHA00237231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0759442Medicaid
OH0759442Medicaid
S11440Medicare UPIN