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General NPI Number Information
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NPI Number | 1255844692
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Entity Type | Individual
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Provider Name | AUDREY R. DAVIS ED.D., MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 494 W BOUGHTON RD STE 4B
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1881
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Country | US
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Telephone | 630-863-0408
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Fax | 815-714-6220
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Provider Business Mailing Address
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Address Line | 215 BROOKWOOD LN E
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City | BOLINGBROOK
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State | IL
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Zip | 60440-5517
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Country | US
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Telephone | 630-863-0408
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Fax | 815-714-6220
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.019648
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License Number State | IL
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