Provider Demographics
NPI:1902397235
Name:PICKETT, EMILY NICOLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:NICOLE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:OH
Mailing Address - Zip Code:44826-9732
Mailing Address - Country:US
Mailing Address - Phone:419-706-8267
Mailing Address - Fax:
Practice Address - Street 1:715 RICHLAND MALL STE D
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3802
Practice Address - Country:US
Practice Address - Phone:419-775-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02139231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314960Medicaid