Individual
TERESA L DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
201 W SPRINGFIELD AVE STE 211, CHAMPAIGN, IL 61820
(217) 621-6180
Mailing address
40 CAMELOT DR, FOND DU LAC, WI 54935-8049
(920) 907-8201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
01/31/2012
Last updated
06/27/2018
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