Provider Demographics
NPI:1033952684
Name:DAVIS, KATHERINE ANNETTE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNETTE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10035 W JAMES ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BUCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:23921-3150
Mailing Address - Country:US
Mailing Address - Phone:434-547-9398
Mailing Address - Fax:
Practice Address - Street 1:15595 W JAMES ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:BUCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:23921-3118
Practice Address - Country:US
Practice Address - Phone:434-969-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist