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General NPI Number Information
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NPI Number | 1912201237
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Entity Type | Individual
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Provider Name | AUDREY K DAVIS M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1009 OLD COUNTRY CLUB RD NW
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City | ROANOKE
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State | VA
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Zip | 24017-2927
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Country | US
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Telephone | 540-767-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 83 TIMBERLINE DR
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City | BLUE RIDGE
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State | VA
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Zip | 24064-1601
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Country | US
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Telephone | 540-525-3260
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202002584
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 01105990
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License Number State |
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