Healthcare Provider Details

I. General information

NPI: 1164346789
Provider Name (Legal Business Name): DEBRA PENNINGTON DAVIS AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SW ROCK CREEK DR
STEVENSON WA
98648-4418
US

IV. Provider business mailing address

PO BOX 1492
STEVENSON WA
98648-1492
US

V. Phone/Fax

Practice location:
  • Phone: 509-427-3850
  • Fax: 509-427-0188
Mailing address:
  • Phone: 509-427-3850
  • Fax: 509-427-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCAAR.CG.70150228
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.70150228
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: