MEDICARE: MARY JAYNE DAVISON M.A., SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP9513	CA

General Provider Information

NPI Number	:	1669531158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JAYNE DAVISON M.A., SLP

Provider Business Mailing Address
First Line	:	1992 W OAKLAND AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92545-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 EUREKA AVE
Second Line	:	SUITE A
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3368
Country	:	US
Telephone Number	:	949-599-0218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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