Individual provider · NPI-1

Joanna Brooke Davis

Speech-Language Pathologist, · Crestview, FL

NPI number1376059907
StatusActive
Last updated in NPPESJul 15, 2020

Details

NPI
1376059907
Entity type
Individual (NPI-1)
Name
Mrs. Joanna Brooke Davis
Sex
Female
Sole proprietor
No
Enumeration date
Dec 19, 2017
Certification date
Jul 15, 2020
Last updated
Jul 15, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
235Z00000X Speech-Language Pathologist,SA15824FLYes

Other names

  • Brooke Davis (Professional Name)

Practice location

930 N Ferdon Blvd
Crestview, FL 32536-1706

Phone 850-331-2987

Mailing address

2411 Halfmoon Ln
Crestview, FL 32536-4374

Phone 850-257-4766

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