Provider Demographics
NPI:1194427658
Name:DAVIS, VICTORIA JEAN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9387 US HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-9624
Mailing Address - Country:US
Mailing Address - Phone:270-952-6734
Mailing Address - Fax:
Practice Address - Street 1:2003 STAPP DR UNIT C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-1601
Practice Address - Country:US
Practice Address - Phone:270-827-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY124502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist