Provider Demographics
NPI:1487964094
Name:DAVIS, KATHRYN H
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 POST ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-255-3669
Mailing Address - Fax:203-255-1173
Practice Address - Street 1:101 NORTH PLAINS INDUSTRIAL ROAD
Practice Address - Street 2:BUILDING 2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-949-9337
Practice Address - Fax:203-284-3779
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist