Provider Demographics
NPI:1558817254
Name:EMERSON, NOAH (MA, SLC, NCC)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:EMERSON
Suffix:
Gender:M
Credentials:MA, SLC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W FULLER AVE
Mailing Address - Street 2:APT 102 D
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2156
Mailing Address - Country:US
Mailing Address - Phone:231-360-5265
Mailing Address - Fax:
Practice Address - Street 1:521 W FULLER AVE
Practice Address - Street 2:APT 102 D
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2156
Practice Address - Country:US
Practice Address - Phone:231-360-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other