Provider Demographics
NPI:1215244082
Name:DAVIDSON, LINDA SUSAN (MA,CCC,SLP,PC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUSAN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MA,CCC,SLP,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ROUND HILL RD
Mailing Address - Street 2:#14C
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3310
Mailing Address - Country:US
Mailing Address - Phone:917-301-4803
Mailing Address - Fax:
Practice Address - Street 1:3265 JOHNSON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:917-301-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist