Healthcare Provider Details

I. General information

NPI: 1437494952
Provider Name (Legal Business Name): ELAINE BLANCHE DAVENPORT M.S. SPEECH PATHOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 O ST
LINCOLN NE
68510-2235
US

IV. Provider business mailing address

5905 O ST
LINCOLN NE
68510-2235
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1000
  • Fax:
Mailing address:
  • Phone: 402-436-1000
  • Fax: 402-330-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1274
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: