Provider Demographics
NPI:1740818244
Name:KVALHEIM, EMILY JOELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOELLE
Last Name:KVALHEIM
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 1:10910 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-0000
Mailing Address - Country:US
Mailing Address - Phone:734-277-1368
Mailing Address - Fax:
Practice Address - Street 1:10910 ROUTE 108
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-0000
Practice Address - Country:US
Practice Address - Phone:734-277-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist