Provider Demographics
NPI:1871893701
Name:DAVIDSON, DEBORAH LEAH (MSC, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEAH
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MSC, 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 SEAVEY ST
Mailing Address - Street 2:APT 2
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4360
Mailing Address - Country:US
Mailing Address - Phone:207-591-5013
Mailing Address - Fax:
Practice Address - Street 1:1600 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1314
Practice Address - Country:US
Practice Address - Phone:207-874-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00906461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist