Provider Demographics
NPI:1588708978
Name:DAVIS, CAROLE ANN (SPPECH PATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SPPECH PATHOLOGIST
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:ANN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:21 GROUND PINE CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5701
Mailing Address - Country:US
Mailing Address - Phone:631-549-9294
Mailing Address - Fax:631-549-9294
Practice Address - Street 1:47 HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4022
Practice Address - Country:US
Practice Address - Phone:631-549-9294
Practice Address - Fax:631-549-9294
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001639-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist