Provider Demographics
NPI:1417203332
Name:PINKHAM, EMILY ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:PINKHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HALL ST STE H
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3442
Mailing Address - Country:US
Mailing Address - Phone:603-228-9160
Mailing Address - Fax:603-224-2776
Practice Address - Street 1:124 HALL ST STE H
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3442
Practice Address - Country:US
Practice Address - Phone:603-228-9160
Practice Address - Fax:603-224-2776
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3105234Medicaid