Provider Demographics
NPI:1720373152
Name:STRAKA, EMILIE L (CCC SLP)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:L
Last Name:STRAKA
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 MALETA LN
Mailing Address - Street 2:#202
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7612
Mailing Address - Country:US
Mailing Address - Phone:720-398-8806
Mailing Address - Fax:720-533-6137
Practice Address - Street 1:757 MALETA LN
Practice Address - Street 2:#202
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7612
Practice Address - Country:US
Practice Address - Phone:720-398-8806
Practice Address - Fax:720-533-6137
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82539863Medicaid