Provider Demographics
NPI:1588187447
Name:LOWELL, EMILIE ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:ROSE
Last Name:LOWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 WASHINGTON ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1240
Mailing Address - Country:US
Mailing Address - Phone:508-505-8031
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST BLDG 3
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-826-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14134184OtherASHA CERTIFICATION OF CLINICAL COMPETENCE
MA76492OtherMASSACHUSETTS STATE LICENSURE IN SPEECH LANGUAGE PATHOLOGY