Provider Demographics
NPI:1750467536
Name:WYCOFF, EMILY H (MED,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:H
Last Name:WYCOFF
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 COLONIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3204
Mailing Address - Country:US
Mailing Address - Phone:540-343-0165
Mailing Address - Fax:540-345-4664
Practice Address - Street 1:2030 COLONIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3204
Practice Address - Country:US
Practice Address - Phone:540-343-0165
Practice Address - Fax:540-345-4664
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195185OtherANTHEM
VA0007790506OtherAETNA
VA240052OtherMAMSI
496535Medicare ID - Type Unspecified