Basic Information
| Provider Information | |||||||||
| NPI: | 1235457227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CARIE | ||||||||
| MiddleName: | JANELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ELLIOTT-DAVIS | ||||||||
| OtherFirstName: | CARIE | ||||||||
| OtherMiddleName: | JANELLE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S. CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9 LACRUE AVENUE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CONCORDVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008785497 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9 LACRUE AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | GLEN MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193421062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005787906 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2010 | ||||||||
| LastUpdateDate: | 11/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 317212 | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.