Provider Demographics
NPI:1043927403
Name:DAVIS, STEPHNIE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHNIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 S CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-5104
Mailing Address - Country:US
Mailing Address - Phone:801-731-1144
Mailing Address - Fax:
Practice Address - Street 1:5320 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6913
Practice Address - Country:US
Practice Address - Phone:801-476-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist