Provider Demographics
NPI:1134453442
Name:KOEHN, EMILY KATHRYN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KATHRYN
Last Name:KOEHN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KATHRYN
Other - Last Name:BUCKMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-2376
Mailing Address - Country:US
Mailing Address - Phone:605-366-4755
Mailing Address - Fax:
Practice Address - Street 1:507 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-2376
Practice Address - Country:US
Practice Address - Phone:605-366-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12118351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist