Provider Demographics
NPI:1679173322
Name:ELWAY, EMILY LEANN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LEANN
Last Name:ELWAY
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 1:362 MEREDITH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-7847
Mailing Address - Country:US
Mailing Address - Phone:270-589-4271
Mailing Address - Fax:
Practice Address - Street 1:362 MEREDITH RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-7847
Practice Address - Country:US
Practice Address - Phone:270-589-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBACB570511103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst