Provider Demographics
NPI:1639744741
Name:BOOTH, EMILY JEANNETTE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEANNETTE
Last Name:BOOTH
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 1:81 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63362-2491
Mailing Address - Country:US
Mailing Address - Phone:163-629-5144
Mailing Address - Fax:
Practice Address - Street 1:81 WILLOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MOSCOW MILLS
Practice Address - State:MO
Practice Address - Zip Code:63362-2491
Practice Address - Country:US
Practice Address - Phone:163-629-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician