Provider Demographics
NPI:1629212824
Name:DAVIS, KATHLEEN GIBSON (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:GIBSON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8600 SNOWDEN RIVER PKWY
Mailing Address - Street 2:#309
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1982
Mailing Address - Country:US
Mailing Address - Phone:877-255-3277
Mailing Address - Fax:410-740-9797
Practice Address - Street 1:8600 SNOWDEN RIVER PKWY
Practice Address - Street 2:#309
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1982
Practice Address - Country:US
Practice Address - Phone:877-255-3277
Practice Address - Fax:410-740-9797
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00615231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist