Provider Demographics
NPI:1487673158
Name:MILAM, EMMETT PAUL (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:PAUL
Last Name:MILAM
Suffix:
Gender:M
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2607 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5620
Mailing Address - Country:US
Mailing Address - Phone:870-933-2510
Mailing Address - Fax:870-972-0929
Practice Address - Street 1:2208 FOWLER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6115
Practice Address - Country:US
Practice Address - Phone:870-931-0808
Practice Address - Fax:870-972-0929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U979OtherBLUE CROSS & BLUE SHIELD