Provider Demographics
NPI:1023599362
Name:DOUGHERTY, EMILY CAITLYN (SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAITLYN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:GRIEKSPOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3223 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2106
Mailing Address - Country:US
Mailing Address - Phone:316-558-3410
Mailing Address - Fax:
Practice Address - Street 1:2258 N LAKEWAY CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1082
Practice Address - Country:US
Practice Address - Phone:316-945-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist