Healthcare Provider Details

I. General information

NPI: 1831827229
Provider Name (Legal Business Name): SUSAN LAWRENCE DAVIS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W QUINCY ST
SAN ANTONIO TX
78212-5163
US

IV. Provider business mailing address

4419 EISENHAUER RD
SAN ANTONIO TX
78218-2609
US

V. Phone/Fax

Practice location:
  • Phone: 210-554-2200
  • Fax:
Mailing address:
  • Phone: 210-843-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: