Provider Demographics
NPI:1922646009
Name:ISRAELSEN, EMILY (SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ISRAELSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12453 S 265 W STE B
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5420
Mailing Address - Country:US
Mailing Address - Phone:801-443-7775
Mailing Address - Fax:801-447-0107
Practice Address - Street 1:12453 S 265 W STE B
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5420
Practice Address - Country:US
Practice Address - Phone:801-443-7775
Practice Address - Fax:801-447-0107
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11560320-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist