Provider Demographics
NPI:1871849695
Name:STAFSLIEN, EMILY H (SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:H
Last Name:STAFSLIEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:H
Other - Last Name:DESPINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:408 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2261
Practice Address - Country:US
Practice Address - Phone:406-535-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3671-154235Z00000X
MTSLP-SP-LIC-4023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist