Basic Information
Provider Information
NPI: 1134200587
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVIS
FirstName: ANNE
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: MS CCC SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CATE
OtherFirstName: ANNE
OtherMiddleName: E
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 425 PATTERSON RD
Address2: SUITE 503
City: GRAND JUNCTION
State: CO
PostalCode: 81506
CountryCode: US
TelephoneNumber: 9702452400
FaxNumber: 9702429092
Practice Location
Address1: 425 PATTERSON RD
Address2: SUITE 503
City: GRAND JUNCTION
State: CO
PostalCode: 81506
CountryCode: US
TelephoneNumber: 9702452400
FaxNumber: 9702429092
Other Information
ProviderEnumerationDate: 10/18/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X  Y Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home