Provider Demographics
NPI:1285922294
Name:DAVIS, BRIAN MARSHALL (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MARSHALL
Last Name:DAVIS
Suffix:
Gender:M
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 1:1518 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4030
Mailing Address - Country:US
Mailing Address - Phone:757-288-3335
Mailing Address - Fax:
Practice Address - Street 1:1518 WOOD AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-4030
Practice Address - Country:US
Practice Address - Phone:757-288-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist