Provider Demographics
NPI:1962854513
Name:WALSH, EMILY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ROARING BROOK TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9681
Mailing Address - Country:US
Mailing Address - Phone:570-430-4366
Mailing Address - Fax:
Practice Address - Street 1:108 TERRACE DR
Practice Address - Street 2:
Practice Address - City:ROARING BROOK TWP
Practice Address - State:PA
Practice Address - Zip Code:18444-9681
Practice Address - Country:US
Practice Address - Phone:570-430-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist