Provider Demographics
NPI:1922668813
Name:BRAUNWART, EMILY MARY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARY
Last Name:BRAUNWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11590 TREMONT CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-7797
Mailing Address - Country:US
Mailing Address - Phone:859-630-1105
Mailing Address - Fax:
Practice Address - Street 1:11590 TREMONT CT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7797
Practice Address - Country:US
Practice Address - Phone:859-630-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty