Individual
MRS. ROBERTA RUTH DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1970 CORBIN RD, GERMANTOWN, TN 38139-4416
(901) 262-9682
Mailing address
2830 WATERLEAF DR, GERMANTOWN, TN 38138-7351
(901) 754-6310
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP0000001460
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000535561
STATE OF TN DEPARTMENT OF EDUCATION
TN
01
—
SP0000001460
TN HEALTH RELATED BOARDS LICENSE
TN
Enumeration date
07/27/2010
Last updated
07/27/2010
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