Provider Demographics
NPI:1790520161
Name:CARLETON, EMILY REECE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:REECE
Last Name:CARLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 COREY RD
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-4117
Mailing Address - Country:US
Mailing Address - Phone:321-917-5435
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD STE 102E
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7544
Practice Address - Country:US
Practice Address - Phone:321-635-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI71412355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant