Provider Demographics
NPI:1699411678
Name:IZYKOWSKI, EMILIE ANN (CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:EMILIE
Middle Name:ANN
Last Name:IZYKOWSKI
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-1227
Mailing Address - Country:US
Mailing Address - Phone:610-387-5605
Mailing Address - Fax:
Practice Address - Street 1:30 WEST AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3322
Practice Address - Country:US
Practice Address - Phone:610-688-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program