Healthcare Provider Details

I. General information

NPI: 1306015391
Provider Name (Legal Business Name): VANESSA L DAVIDSON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 READING RD
MASON OH
45040-1666
US

IV. Provider business mailing address

975 KINGSVIEW DR SUITE 400
LEBANON OH
45036-9562
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-2551
  • Fax: 513-459-7300
Mailing address:
  • Phone: 513-228-7854
  • Fax: 513-228-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7096
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: