Provider Demographics
NPI:1578244398
Name:KRATTLEY, EMILY RAE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE
Last Name:KRATTLEY
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 1:711 N EVERGREEN RD APT 3022
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7557
Mailing Address - Country:US
Mailing Address - Phone:262-758-3433
Mailing Address - Fax:
Practice Address - Street 1:1829 N GRAND
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-1706
Practice Address - Country:US
Practice Address - Phone:480-472-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP14648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist