Provider Demographics
NPI:1902217201
Name:MASHBURN, EMILY (MS ED CCC SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:MS ED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 ST CHARLES PLACE RD
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8766
Mailing Address - Country:US
Mailing Address - Phone:716-868-1023
Mailing Address - Fax:
Practice Address - Street 1:763 ST CHARLES PLACE RD
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-8766
Practice Address - Country:US
Practice Address - Phone:716-868-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13414OtherSTATE LICENSE