Provider Demographics
NPI:1487373924
Name:DAVENPORT, MATTHEW (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1122
Mailing Address - Country:US
Mailing Address - Phone:281-799-3883
Mailing Address - Fax:
Practice Address - Street 1:424 N LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1122
Practice Address - Country:US
Practice Address - Phone:281-799-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist