Provider Demographics
NPI:1801216668
Name:EMMONS, SENTA LYNN (CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:SENTA
Middle Name:LYNN
Last Name:EMMONS
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:SENTA
Other - Middle Name:LYNN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP/L
Mailing Address - Street 1:2435 DAVISSON ST
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1716
Mailing Address - Country:US
Mailing Address - Phone:630-234-1092
Mailing Address - Fax:
Practice Address - Street 1:2435 DAVISSON ST
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1716
Practice Address - Country:US
Practice Address - Phone:630-234-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2015885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist