Provider Demographics
NPI:1780431726
Name:GILSDORF, EMILY ANN (SLPA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:GILSDORF
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 SW WESTERN BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-7602
Mailing Address - Country:US
Mailing Address - Phone:541-377-5220
Mailing Address - Fax:
Practice Address - Street 1:33461 SE PEORIA RD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2521
Practice Address - Country:US
Practice Address - Phone:541-704-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA08682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant