Heather Calli Davis Gagnon, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP012552 Issued in GA

Practice address

204 W Haralson St
Lagrange, GA 30240-2722

Phone

(706) 773-7931

NPI assigned

May 16, 2023

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Three Sparrows Therapy, LLC

  • Multi-Specialty Clinic/Center
  • Lagrange, GA
  • NPI 1831881259
  NPD (past)

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1891486403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3090 JUDGE BROWN RD",
            "city": "VALLEY",
            "state": "AL",
            "postal_code": "368547412",
            "telephone_number": "706-773-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W HARALSON ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402722",
            "telephone_number": "706-773-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS GAGNON",
        "first_name": "HEATHER",
        "middle_name": "CALLI",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP012552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie N Dantzler
• Shari Kay Dark-Reynolds
• Amanda Davenport, L.C.S.W.
• David Eugene Martin MD PC
• Lasabree Davidson
• Joshua Young Davis, DPT
• Marcia Annette Davis, RN
• Laneisha Ann Dawkins, APRN, NP-C
• Holly McMahon Dawson, M.D.
• Kevin De la Espada

• Speech-Language Pathologist in Lagrange, GA
• Providers in Lagrange, 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 Dec 14, 2023; 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.