Provider Demographics
NPI:1629692686
Name:BAREFIELD, EMILY BENNETT (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BENNETT
Last Name:BAREFIELD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6338 RIVERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4661
Mailing Address - Country:US
Mailing Address - Phone:912-614-4774
Mailing Address - Fax:
Practice Address - Street 1:303 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5229
Practice Address - Country:US
Practice Address - Phone:912-283-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003093235Z00000X
GASLP011424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist