Jacqueline D Davis, M.ED. CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP001725 Issued in GA

Practice address

134 Woodcrest Cir
Warner Robins, GA 31093-3034

Phone

(478) 929-0513

Fax

(478) 929-0513

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Playground Children'S Therapy, LLC

  • Speech-Language Pathologist
  • Warner Robins, GA
  • NPI 1295340776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1083750178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 WOODCREST CIR",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933034",
            "telephone_number": "478-929-0513",
            "fax_number": "478-929-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 WOODCREST CIR",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933034",
            "telephone_number": "478-929-0513",
            "fax_number": "478-929-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "M.ED. CCCSLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP001725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00661746C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Diana Davis, RBT
• Essie Novella Davis
• Gabrielle Davis
• Heather L Davis
• Indya Davis
• Katherine Davis
• Mary Teresa Davis, LMT
• Pamela Jean Davis, LPC
• Tamika McCrary Davis, FNP-C
• Valarie Davis, RN

• Speech-Language Pathologist in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.