Provider Demographics
NPI:1841337250
Name:BUCKBERRY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BUCKBERRY
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 1:845 4TH AVE STE 302A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1428
Mailing Address - Country:US
Mailing Address - Phone:304-523-1164
Mailing Address - Fax:
Practice Address - Street 1:845 4TH AVE STE 302A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1428
Practice Address - Country:US
Practice Address - Phone:304-523-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist