Provider Demographics
NPI:1770914426
Name:DAVIDOV, KATERINA (SLP)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:DAVIDOV
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 97TH ST APT 9M
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1235
Mailing Address - Country:US
Mailing Address - Phone:917-294-2262
Mailing Address - Fax:
Practice Address - Street 1:6125 97TH ST APT 9M
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1235
Practice Address - Country:US
Practice Address - Phone:917-294-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist