Provider Demographics
NPI:1346916376
Name:PHILLIPS PEREIRA, EMILY ELISE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELISE
Last Name:PHILLIPS PEREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1930
Mailing Address - Country:US
Mailing Address - Phone:203-676-9759
Mailing Address - Fax:
Practice Address - Street 1:22 MOTT ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1930
Practice Address - Country:US
Practice Address - Phone:203-676-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist