Provider Demographics
NPI:1205405438
Name:SIMON, EMILY ISABEL ZELLER (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ISABEL ZELLER
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211A IRELAND DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3372
Mailing Address - Country:US
Mailing Address - Phone:910-912-2210
Mailing Address - Fax:910-912-3372
Practice Address - Street 1:1211A IRELAND DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3372
Practice Address - Country:US
Practice Address - Phone:910-912-2210
Practice Address - Fax:910-912-3372
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist