Provider Demographics
NPI:1891490603
Name:HACKMAN, EMILY MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:HACKMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1710
Mailing Address - Country:US
Mailing Address - Phone:859-663-5557
Mailing Address - Fax:
Practice Address - Street 1:18 N FORT THOMAS AVE STE 302
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1595
Practice Address - Country:US
Practice Address - Phone:859-441-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist