Provider Demographics
NPI:1811279367
Name:DAVIDSON, CARLA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MARIE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:M
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 ALCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2424
Mailing Address - Country:US
Mailing Address - Phone:585-966-4400
Mailing Address - Fax:
Practice Address - Street 1:200 ALCOTT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2424
Practice Address - Country:US
Practice Address - Phone:585-966-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008118-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist