Provider Demographics
NPI:1831267319
Name:PETROUS, EMILY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:PETROUS
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 1:253 MARK HANNAH CT
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1319
Mailing Address - Country:US
Mailing Address - Phone:734-944-0475
Mailing Address - Fax:
Practice Address - Street 1:253 MARK HANNAH CT
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1319
Practice Address - Country:US
Practice Address - Phone:734-944-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12082665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist