Provider Demographics
NPI:1578761771
Name:DAVIS, GRETCHEN LEE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GREELEY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4433
Mailing Address - Country:US
Mailing Address - Phone:603-635-6177
Mailing Address - Fax:
Practice Address - Street 1:22 GREELEY ST STE 6
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4433
Practice Address - Country:US
Practice Address - Phone:603-635-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1617235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP5418OtherSLP LICENSE NUMBER