MEDICARE: MATTHEW DAVENPORT MS CF-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
1	235Z00000X	Speech-Language Pathologist	119304	TX

General Provider Information

NPI Number	:	1487373924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVENPORT MS CF-SLP

Provider Business Mailing Address
First Line	:	424 N LIVE OAK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1122
Country	:	US
Telephone Number	:	281-799-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 N LIVE OAK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1122
Country	:	US
Telephone Number	:	281-799-3883
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	10/02/2022

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