Provider Demographics
NPI:1982942835
Name:DAVIS, AMELIA BLAKE (SLP)
Entity type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:BLAKE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 ESPERANZA XING
Mailing Address - Street 2:APT 5489
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7814
Mailing Address - Country:US
Mailing Address - Phone:206-251-0191
Mailing Address - Fax:
Practice Address - Street 1:3210 ESPERANZA XING
Practice Address - Street 2:APT 5489
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7814
Practice Address - Country:US
Practice Address - Phone:206-251-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist