Provider Demographics
NPI:1720497217
Name:KAUTZ, EMILY ELISABETH (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELISABETH
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ELISABETH
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED CCC-SLP
Mailing Address - Street 1:7947 TARTAN FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8778
Mailing Address - Country:US
Mailing Address - Phone:614-323-9469
Mailing Address - Fax:
Practice Address - Street 1:7947 TARTAN FIELDS DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8778
Practice Address - Country:US
Practice Address - Phone:614-323-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0220583Medicaid