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General NPI Number Information
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NPI Number | 1235320235
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Entity Type | Individual
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Provider Name | JULIANA BROOK DAVIS TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 2227 W MAIN ST STE 3
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4207
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Country | US
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Telephone | 501-985-9944
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Fax | 501-985-6590
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Provider Business Mailing Address
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Address Line | 2227 W MAIN ST STE 3
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4207
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Country | US
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Telephone | 501-985-9944
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Fax | 501-985-6590
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State |
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