Provider Demographics
NPI:1912648932
Name:DAVIS, MIRANDA JOHNSON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:JOHNSON
Last Name:DAVIS
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 1:6904 COUNTY ROAD 9
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:AL
Mailing Address - Zip Code:36785-5033
Mailing Address - Country:US
Mailing Address - Phone:334-413-0038
Mailing Address - Fax:
Practice Address - Street 1:115 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3336
Practice Address - Country:US
Practice Address - Phone:334-491-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist