Provider Demographics
NPI:1215679519
Name:DAVIES, KATHRYN A (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SUMAC ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4561
Mailing Address - Country:US
Mailing Address - Phone:832-287-9764
Mailing Address - Fax:
Practice Address - Street 1:301 W BRAZOSWOOD DR
Practice Address - Street 2:
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531-3520
Practice Address - Country:US
Practice Address - Phone:979-730-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518089556Medicaid