Provider Demographics
NPI:1598282006
Name:CARSON, EMMA (SLP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:DOMARACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13857 APPLE HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-6199
Mailing Address - Country:US
Mailing Address - Phone:304-267-8604
Mailing Address - Fax:
Practice Address - Street 1:13857 APPLE HARVEST DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6199
Practice Address - Country:US
Practice Address - Phone:304-267-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD08588235Z00000X
WV1771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist