Provider Demographics
NPI:1720237654
Name:DAVIDSON, SALLEY B (M AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:SALLEY
Middle Name:B
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:M AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7184
Mailing Address - Country:US
Mailing Address - Phone:843-763-0544
Mailing Address - Fax:843-576-2089
Practice Address - Street 1:497 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7184
Practice Address - Country:US
Practice Address - Phone:843-763-0544
Practice Address - Fax:843-576-2089
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC275237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ359785449Medicare PIN