Provider Demographics
NPI:1508412560
Name:BRYAN, EMILY KETELSEN
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KETELSEN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HUFF RD NW APT 530
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4324
Mailing Address - Country:US
Mailing Address - Phone:678-521-9762
Mailing Address - Fax:
Practice Address - Street 1:1133 HUFF RD NW APT 530
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4324
Practice Address - Country:US
Practice Address - Phone:678-521-9762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist