Provider Demographics
NPI:1780726315
Name:DAVISON, COLETTE VICTORIA (BS, MED, SLPA)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:VICTORIA
Last Name:DAVISON
Suffix:
Gender:F
Credentials:BS, MED, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11063
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0002
Mailing Address - Country:US
Mailing Address - Phone:480-276-8414
Mailing Address - Fax:
Practice Address - Street 1:3150 N ARIZONA AVE
Practice Address - Street 2:STE 112
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7168
Practice Address - Country:US
Practice Address - Phone:480-347-8938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA84832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant