Provider Demographics
NPI:1053866269
Name:GENSKE, EMILY A (SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:GENSKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2868
Mailing Address - Country:US
Mailing Address - Phone:918-341-4343
Mailing Address - Fax:918-341-8687
Practice Address - Street 1:1071 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2868
Practice Address - Country:US
Practice Address - Phone:918-341-4343
Practice Address - Fax:918-341-8687
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist