Doctor Name: | SHELLEY DAVIDSON |
NPI Number: | 1578979035 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 101521 |
Business Practice Address: | 6850 Manhattan Blvd Ste 204 Ft Worth, TX - 761201210 |
Business Phone Number: | 8175071500 |
Business Fax Number: | |
Mailing Address: | 104 Blue Bonnet Cir, JUSTIN |
State: | TX |
Postal Code: | 762475813 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/05/2014 |
NPI Last Update Date: | 07/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 101521 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |