Provider Demographics
NPI:1205153616
Name:DAVIS, SARA GABRIELLE (SLP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:GABRIELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:GABRIELLE
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4530 E SHEA BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6042
Mailing Address - Country:US
Mailing Address - Phone:602-264-4834
Mailing Address - Fax:602-254-5178
Practice Address - Street 1:4530 E SHEA BLVD STE 180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6042
Practice Address - Country:US
Practice Address - Phone:602-264-4834
Practice Address - Fax:602-254-5178
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
AZSLP12784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist