Provider Demographics
NPI:1497461743
Name:HASTINGS, EMMA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:HASTINGS
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 1:1238 BROADWAY APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1703
Mailing Address - Country:US
Mailing Address - Phone:609-741-0224
Mailing Address - Fax:
Practice Address - Street 1:1238 BROADWAY APT 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:609-741-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78498-SP-SL.235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist