Individual
MRS. LISA MICHELLE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD-SLP-CCC
Contact information
Practice address
118 SCOTTS BLUFF DR, SIMPSONVILLE, SC 29681
(864) 561-5838
(855) 849-5178
Mailing address
118 SCOTTS BLUFF DR, SIMPSONVILLE, SC 29681-8011
(864) 561-5838
(855) 849-5178
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4063
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA1007
—
SC
Enumeration date
05/18/2009
Last updated
06/13/2018
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