Provider Demographics
NPI:1366840746
Name:PANEPUCCI, EMMA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:PANEPUCCI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9675 STATE ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758-9727
Mailing Address - Country:US
Mailing Address - Phone:740-342-4873
Mailing Address - Fax:
Practice Address - Street 1:6172 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2984
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:877-856-7133
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 10967235Z00000X
TN6648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist