Provider Demographics
NPI:1558613471
Name:PERRY, EMILY SUZANNE (SLP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:SUZANNE
Last Name:PERRY
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 1:44602 N GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9039
Mailing Address - Country:US
Mailing Address - Phone:509-837-3641
Mailing Address - Fax:509-837-0403
Practice Address - Street 1:44602 N GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-9039
Practice Address - Country:US
Practice Address - Phone:509-837-3641
Practice Address - Fax:509-837-0403
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60285561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist