Provider Demographics
NPI:1811234214
Name:HORNBACK, EMILY ROXANNA (MS, CCC-SLP, BCS-S)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROXANNA
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1924
Mailing Address - Country:US
Mailing Address - Phone:704-299-1083
Mailing Address - Fax:
Practice Address - Street 1:234 RUSHING CREEK DR UNIT F
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5840
Practice Address - Country:US
Practice Address - Phone:704-299-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1309111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist