Teresa L Davenport, PhD
Psychologist in Champaign, IL. Individual provider (NPI-1).
NPI number1851663256
StatusActive
Last updated in NPPESJun 27, 2018
Details
- NPI
- 1851663256
- Entity type
- Individual (NPI-1)
- Name
- Teresa L Davenport
- Credential
- PhD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 31, 2012
- Last updated
- Jun 27, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | – | – | Yes |
Practice location
201 W Springfield Ave Ste 211Champaign, IL 61820
Phone 217-621-6180
Mailing address
40 Camelot DrFond Du Lac, WI 54935-8049
Phone 920-907-8201
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