Provider Demographics
NPI:1831748953
Name:DAVENPORT, BRANDY (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials: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 1:176 VALLEY ST NW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2859
Mailing Address - Country:US
Mailing Address - Phone:276-628-9547
Mailing Address - Fax:
Practice Address - Street 1:176 VALLEY ST NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2859
Practice Address - Country:US
Practice Address - Phone:276-628-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA21001002419237700000X
VA2201001751231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist