Provider Demographics
NPI:1508008103
Name:DAVIS, MICHELE DENISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DENISE
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 1:1530 WESTFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7288
Mailing Address - Country:US
Mailing Address - Phone:214-934-8721
Mailing Address - Fax:469-698-9587
Practice Address - Street 1:1530 WESTFIELD LN
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7288
Practice Address - Country:US
Practice Address - Phone:214-934-8721
Practice Address - Fax:469-698-9587
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist