Provider Demographics
NPI:1811557572
Name:EISERT, EMMA KATHRYN (CF-SLP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHRYN
Last Name:EISERT
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4304
Mailing Address - Country:US
Mailing Address - Phone:815-434-0857
Mailing Address - Fax:
Practice Address - Street 1:1013 ADAMS ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4304
Practice Address - Country:US
Practice Address - Phone:815-434-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2420053852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242005385OtherIDFPR LICENSE NUMBER