Healthcare Provider Details

I. General information

NPI: 1174456404
Provider Name (Legal Business Name): LAUREN DAVIDSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S MANNING BLVD.
ALBANY NY
12208
US

IV. Provider business mailing address

18 ELAINE CT.
LATHAM NY
12110
US

V. Phone/Fax

Practice location:
  • Phone: 518-437-5696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036436-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: