Provider Demographics
NPI:1750703013
Name:RACITANO, EMILY LYN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LYN
Last Name:RACITANO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:45 SYCAMORE AVE
Mailing Address - Street 2:APT 424
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6710
Mailing Address - Country:US
Mailing Address - Phone:585-968-2000
Mailing Address - Fax:585-968-3898
Practice Address - Street 1:1801 OLD TROLLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8283
Practice Address - Country:US
Practice Address - Phone:843-871-3235
Practice Address - Fax:843-871-3233
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC5426235Z00000X
NY022012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist