Provider Demographics
NPI:1407403785
Name:HERNDON, EMILY DAISY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DAISY
Last Name:HERNDON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1676 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1162
Mailing Address - Country:US
Mailing Address - Phone:954-661-6535
Mailing Address - Fax:
Practice Address - Street 1:1676 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1162
Practice Address - Country:US
Practice Address - Phone:352-562-3618
Practice Address - Fax:352-240-3392
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14256850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist