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NPI Code Detail

MEDICARE: MRS. KELLY MARIE DAVIDSON M.S., CCC-SLP

MEDICARE: MRS. KELLY MARIE DAVIDSON M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist10218OH

General Provider Information

NPI Number : 1053617282
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY MARIE DAVIDSON M.S., CCC-SLP
Provider Business Mailing Address
First Line : 199 CHURCH ST
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-2406
Country : US
Telephone Number : 708-372-0226
Fax Number :
Provider Business Practice Location Address
First Line : 10098 BIG BEAR CREEK RD
Second Line :
City : LUCASVILLE
State : OH
Zip : 45648-9168
Country : US
Telephone Number : 740-259-5536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2011
Last Update Date : 07/24/2014

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Directions to “ MRS. KELLY MARIE DAVIDSON M.S., CCC-SLP” Practice Location

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