Provider Demographics
NPI:1659939502
Name:SPEAKES, EMILY (MCD, CF-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SPEAKES
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8473 IRIE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-4802
Mailing Address - Country:US
Mailing Address - Phone:208-965-0808
Mailing Address - Fax:
Practice Address - Street 1:8473 IRIE LN
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-4802
Practice Address - Country:US
Practice Address - Phone:208-965-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist