Basic Information
| Provider Information | |||||||||
| NPI: | 1952709248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIE | ||||||||
| FirstName: | ILA | ||||||||
| MiddleName: | LINDSEY | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3940 WOSLEY DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761332628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148088746 | ||||||||
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| Practice Location | |||||||||
| Address1: | 721 DUNAWAY LN | ||||||||
| Address2: | |||||||||
| City: | AZLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760202605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174442536 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2014 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 24882 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.