Individual
MRS. LISA MABRY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP, CCC-SLP
Contact information
Practice address
738 N GREEN RIVER RD, GAFFNEY, SC 29341-5209
(864) 461-5228
Mailing address
738 N GREEN RIVER RD, GAFFNEY, SC 29341-5209
(864) 461-5228
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1532
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SAO147
—
SC
Enumeration date
05/24/2007
Last updated
07/08/2007
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