Provider Demographics
NPI:1457603524
Name:DAVIS, JUSTINE NOLA (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:NOLA
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 1:520 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2602
Mailing Address - Country:US
Mailing Address - Phone:724-430-1127
Mailing Address - Fax:724-430-2438
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2602
Practice Address - Country:US
Practice Address - Phone:724-430-1127
Practice Address - Fax:724-430-2438
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist