Provider Demographics
NPI:1265153514
Name:CHEEKOTI, EMILY RUTH
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RUTH
Last Name:CHEEKOTI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:RUTH
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1360
Mailing Address - Country:US
Mailing Address - Phone:817-814-2000
Mailing Address - Fax:
Practice Address - Street 1:100 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1360
Practice Address - Country:US
Practice Address - Phone:817-814-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659249401Medicaid