Provider Demographics
NPI:1184163446
Name:DAVIS, RODNEISHA CHANELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:RODNEISHA
Middle Name:CHANELLE
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 1:10482 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:628-233-2311
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist