MEDICARE: RAUSHANAH DAVENPORT LCSW

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	1041C0700X	Clinical Social Worker	6801120450	MI

General Provider Information

NPI Number	:	1578455697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUSHANAH DAVENPORT LCSW

Provider Business Mailing Address
First Line	:	3420 EMMONS AVE
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5618
Country	:	US
Telephone Number	:	989-714-8150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 EMMONS AVE
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5618
Country	:	US
Telephone Number	:	989-714-8150
Fax Number	:

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

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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