Provider Demographics
NPI:1669083614
Name:SIMON, EMILY ALEXANDER (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ALEXANDER
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 BURGOYNE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5820
Mailing Address - Country:US
Mailing Address - Phone:713-613-1321
Mailing Address - Fax:
Practice Address - Street 1:1150 BLALOCK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7421
Practice Address - Country:US
Practice Address - Phone:713-574-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty