Provider Demographics
NPI:1881114031
Name:DAVES, RITA CARRIE (MS/CCC/SLP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:CARRIE
Last Name:DAVES
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 HAMILTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2977
Mailing Address - Country:US
Mailing Address - Phone:860-578-1300
Mailing Address - Fax:860-951-7729
Practice Address - Street 1:83 PILGRIM DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1910
Practice Address - Country:US
Practice Address - Phone:860-558-2637
Practice Address - Fax:860-558-2637
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty