Provider Demographics
NPI:1174946040
Name:DAVIS, DENISE F (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:F
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 1:981 VALCOUR DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1862
Mailing Address - Country:US
Mailing Address - Phone:225-456-6293
Mailing Address - Fax:225-678-5582
Practice Address - Street 1:5100 OSBORNE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-8429
Practice Address - Country:US
Practice Address - Phone:225-456-6293
Practice Address - Fax:225-678-5582
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5212235Z00000X
235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist