Provider Demographics
NPI:1225608706
Name:TOZIER, EMMIE MACKENZIE COSTEN (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:EMMIE
Middle Name:MACKENZIE COSTEN
Last Name:TOZIER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:EMMIE
Other - Middle Name:MACKENZIE
Other - Last Name:COSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1933
Mailing Address - Country:US
Mailing Address - Phone:919-577-6807
Mailing Address - Fax:
Practice Address - Street 1:1520 GLENWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2264
Practice Address - Country:US
Practice Address - Phone:919-577-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22032113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22032113OtherTEMPORARY NC SLP LICENSE