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General NPI Number Information
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NPI Number | 1578979035
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Entity Type | Individual
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Provider Name | SHELLEY DAVIDSON
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Gender | Female
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Dates
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Enumeration Date | 07/05/2014
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Last Update Date | 07/05/2014
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Provider Practice Location Address
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Address Line | 6850 MANHATTAN BLVD STE 204
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City | FT WORTH
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State | TX
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Zip | 76120-1210
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Country | US
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Telephone | 817-507-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 104 BLUE BONNET CIR
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City | JUSTIN
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State | TX
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Zip | 76247-5813
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Country | US
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Telephone |
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 101521
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License Number State | TX
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