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NPI Code Detail

MEDICARE: DAVIDA LIGHTSEY M.A., CCC-SLP

MEDICARE: DAVIDA LIGHTSEY M.A., 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 PathologistSL009828PA

General Provider Information

NPI Number : 1770894537
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVIDA LIGHTSEY M.A., CCC-SLP
Provider Business Mailing Address
First Line : 265 W MOUNT PLEASANT AVE
Second Line : APT B9
City : PHILADELPHIA
State : PA
Zip : 19119-2458
Country : US
Telephone Number : 215-821-8338
Fax Number :
Provider Business Practice Location Address
First Line : 10400 ROOSEVELT BLVD
Second Line : REHAB DEPT
City : PHILADELPHIA
State : PA
Zip : 19116-3905
Country : US
Telephone Number : 215-698-5784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2010
Last Update Date : 06/27/2010

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