Provider Demographics
NPI:1619309242
Name:CARMODY, EMILY A (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:A
Last Name:CARMODY
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 1:210 NOLAND ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3513
Mailing Address - Country:US
Mailing Address - Phone:703-298-7425
Mailing Address - Fax:
Practice Address - Street 1:210 NOLAND ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3513
Practice Address - Country:US
Practice Address - Phone:703-298-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist