Provider Demographics
NPI:1952709248
Name:DAVIE, ILA LINDSEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ILA
Middle Name:LINDSEY
Last Name:DAVIE
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 1:3940 WOSLEY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2628
Mailing Address - Country:US
Mailing Address - Phone:214-808-8746
Mailing Address - Fax:
Practice Address - Street 1:721 DUNAWAY LN
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2605
Practice Address - Country:US
Practice Address - Phone:817-444-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist