Provider Demographics
NPI:1285709071
Name:WEAVER, DAVIDA LYNN PARSONS (MA CCC SLP)
Entity type:Individual
Prefix:MS
First Name:DAVIDA
Middle Name:LYNN PARSONS
Last Name:WEAVER
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 1:510 E NORTH BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4114
Mailing Address - Country:US
Mailing Address - Phone:614-263-5151
Mailing Address - Fax:
Practice Address - Street 1:510 E NORTH BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4114
Practice Address - Country:US
Practice Address - Phone:614-263-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP05563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH062447Medicaid
OH000000246469OtherANTHEM GRP #
OH366549Medicare ID - Type UnspecifiedGRP #