1073758942 NPI number — MS. KATHLEEN ANNE DAVIS C.C.C./SLP

Table of content: MS. KATHLEEN ANNE DAVIS C.C.C./SLP (NPI 1073758942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073758942 NPI number — MS. KATHLEEN ANNE DAVIS C.C.C./SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
KATHLEEN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.C.C./SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073758942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
594 NAHATAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-762-1080
Provider Business Mailing Address Fax Number:
781-762-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 ACCESS RD
Provider Second Line Business Practice Location Address:
SUITE 28
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-823-9079
Provider Business Practice Location Address Fax Number:
781-762-3122
Provider Enumeration Date:
12/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2214 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 469002 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0377856 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SP0087 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626560 . This is a "HARVARD PILGRIM HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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