Provider Demographics
NPI:1114204955
Name:SPADE, EMILY MICHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELLE
Last Name:SPADE
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 1:160 GREENE PLZ
Mailing Address - Street 2:RTS 21 & 79
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8142
Mailing Address - Country:US
Mailing Address - Phone:724-852-2504
Mailing Address - Fax:724-852-2547
Practice Address - Street 1:160 GREENE PLZ
Practice Address - Street 2:RTS 21 & 79
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8142
Practice Address - Country:US
Practice Address - Phone:724-852-2504
Practice Address - Fax:724-852-2547
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist