Provider Demographics
NPI:1033615182
Name:FULLER-CAVANAGH, EMILY M (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:M
Last Name:FULLER-CAVANAGH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 OVERLOOK RD APT 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2463
Mailing Address - Country:US
Mailing Address - Phone:330-719-7998
Mailing Address - Fax:
Practice Address - Street 1:9685 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094-8503
Practice Address - Country:US
Practice Address - Phone:440-256-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist