Provider Demographics
NPI:1063647758
Name:CANNAVARO, EMILY (MS, SLP, LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CANNAVARO
Suffix:
Gender:F
Credentials:MS, SLP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 GISE ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-8406
Mailing Address - Country:US
Mailing Address - Phone:541-517-4492
Mailing Address - Fax:
Practice Address - Street 1:213 DECATUR ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-4623
Practice Address - Country:US
Practice Address - Phone:541-517-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13221235Z00000X
WAMA60940374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist