Provider Demographics
NPI:1629545355
Name:VAN LAAN, EMMIE CULCLASURE (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMMIE
Middle Name:CULCLASURE
Last Name:VAN LAAN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SPORTSMAN ISLAND DR STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8524
Mailing Address - Country:US
Mailing Address - Phone:478-954-6167
Mailing Address - Fax:
Practice Address - Street 1:142 SPORTSMAN ISLAND DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8524
Practice Address - Country:US
Practice Address - Phone:478-954-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7425235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist