Healthcare Provider Details

I. General information

NPI: 1871423053
Provider Name (Legal Business Name): JACQUELINE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4862 JAYBEE LN
WINTERS CA
95694-9705
US

IV. Provider business mailing address

4862 JAYBEE LN
WINTERS CA
95694-9705
US

V. Phone/Fax

Practice location:
  • Phone: 530-304-5979
  • Fax:
Mailing address:
  • Phone: 530-304-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: