Provider Demographics
NPI:1740705599
Name:DESILET, EMILY JEANNE (MA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JEANNE
Last Name:DESILET
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S WEBB ST
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-9040
Mailing Address - Country:US
Mailing Address - Phone:715-253-2125
Mailing Address - Fax:
Practice Address - Street 1:604 S WEBB ST
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9040
Practice Address - Country:US
Practice Address - Phone:715-253-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4513-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist