Healthcare Provider Details

I. General information

NPI: 1093799488
Provider Name (Legal Business Name): CHRISTINE HERRICK DAVIS M.A., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 1100
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

1809 GARDEN HWY
SACRAMENTO CA
95833-9737
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3437
  • Fax: 916-454-2703
Mailing address:
  • Phone: 916-641-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP6668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: