Provider Demographics
NPI:1790065498
Name:CANTOR, EMILY REBECCA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:CANTOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 OLANDWOOD CT
Mailing Address - Street 2:101
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1447
Mailing Address - Country:US
Mailing Address - Phone:301-570-7505
Mailing Address - Fax:
Practice Address - Street 1:3407 OLANDWOOD CT
Practice Address - Street 2:101
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1447
Practice Address - Country:US
Practice Address - Phone:301-570-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist