Provider Demographics
NPI:1467279414
Name:ANDERSON, EMILY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NEWBERGER RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4038
Mailing Address - Country:US
Mailing Address - Phone:614-477-0978
Mailing Address - Fax:
Practice Address - Street 1:5424 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3453
Practice Address - Country:US
Practice Address - Phone:813-335-1173
Practice Address - Fax:813-996-9691
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12521235Z00000X
FLSI7219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist