Provider Demographics
NPI:1497882294
Name:LIBLA, EMILY C (SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:LIBLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 NW JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-8005
Mailing Address - Country:US
Mailing Address - Phone:816-228-4310
Mailing Address - Fax:816-228-4365
Practice Address - Street 1:3421 NW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8005
Practice Address - Country:US
Practice Address - Phone:816-228-4310
Practice Address - Fax:816-228-4365
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist