Provider Demographics
NPI:1477380186
Name:EXLINE, EMILY IRENE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:IRENE
Last Name:EXLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 WASHINGTON AVE SE APT 644
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4106
Mailing Address - Country:US
Mailing Address - Phone:715-370-0692
Mailing Address - Fax:
Practice Address - Street 1:17645 JUNIPER PATH STE 205
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7491
Practice Address - Country:US
Practice Address - Phone:952-378-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist