Provider Demographics
NPI:1386967032
Name:DAVIS, VIRGINIA LEE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 REDFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1018
Mailing Address - Country:US
Mailing Address - Phone:516-431-9038
Mailing Address - Fax:
Practice Address - Street 1:49 REDFIELD RD.
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1018
Practice Address - Country:US
Practice Address - Phone:516-431-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002292-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist