MEDICARE: MS. KAREN LYNN 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.6907	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	:	1457776551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN LYNN DAVIS

Provider Business Mailing Address
First Line	:	4600 DETROIT AVE
Second Line	:	MAX HAYES HIGH SCHOOL
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2215
Country	:	US
Telephone Number	:	216-643-8674
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 DETROIT AVE
Second Line	:	MAX HAYES HIGH SCHOOL
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2215
Country	:	US
Telephone Number	:	216-643-8674
Fax Number	:

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

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	02/26/2014

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Directions to “ MS. KAREN LYNN DAVIS ” Practice Location

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