MEDICARE: MRS. JAMIE DAVIS

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
1	235Z00000X	Speech-Language Pathologist	SP 10541	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427451251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE DAVIS

Provider Business Mailing Address
First Line	:	22695 STATE ROUTE 751
Second Line	:
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-9737
Country	:	US
Telephone Number	:	740-502-5856
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 W UNION AVE
Second Line	:
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-1150
Country	:	US
Telephone Number	:	740-502-5856
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2014
Last Update Date	:	10/07/2014

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Directions to “ MRS. JAMIE DAVIS ” Practice Location

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