Individual provider Active NPI

Deborah Lynne Davison, SLP

  • Speech-Language Pathologist
  • Petaluma, CA
National Provider Identifier
1144364407
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP13919 Issued in CA
Practice address
1301 Redwood Way Ste 165
Petaluma, CA 94954-1136
Phone
(707) 763-6419
Fax
(707) 763-2537
NPI assigned
Feb 19, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP13919 CA Primary

Addresses

Primary practice location

1301 Redwood Way Ste 165
Petaluma, CA 94954-1136

Mailing address

1645 Wynoochee Way
Petaluma, CA 94954-2332
Phone (707) 763-6419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SP13919CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Walker Speech Therapy, Inc. Speech-Language Pathologist Past Accepting new patients
Speech Pathology Services of Marin Sonoma Incorportated Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144364407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 WYNOOCHEE WAY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542332",
            "telephone_number": "707-763-6419",
            "fax_number": "707-763-2537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 REDWOOD WAY STE 165",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541136",
            "telephone_number": "707-763-6419",
            "fax_number": "707-763-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVISON",
        "first_name": "DEBORAH",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP13919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.