Provider Demographics
NPI:1609382514
Name:ADE, EMILY ELIZABETH
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:ADE
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 1:301 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HERRICK
Mailing Address - State:IL
Mailing Address - Zip Code:62431-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HERRICK
Practice Address - State:IL
Practice Address - Zip Code:62431-1001
Practice Address - Country:US
Practice Address - Phone:618-428-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist