Provider Demographics
NPI:1609395482
Name:CORK, EMILY NICOLE (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:NICOLE
Last Name:CORK
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3254 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9707
Mailing Address - Country:US
Mailing Address - Phone:815-742-7507
Mailing Address - Fax:
Practice Address - Street 1:2311 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:IL
Practice Address - Zip Code:61011-9321
Practice Address - Country:US
Practice Address - Phone:815-547-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL857566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty