Provider Demographics
NPI:1629347547
Name:VONDERHAAR, EMILY (M ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VONDERHAAR
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEREDITH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5237
Mailing Address - Country:US
Mailing Address - Phone:919-484-0012
Mailing Address - Fax:
Practice Address - Street 1:100 MEREDITH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5237
Practice Address - Country:US
Practice Address - Phone:919-484-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist