Provider Demographics
NPI:1881103406
Name:BYRD, EMILY KATHRYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:BYRD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CLAUGHTON ISLAND DR APT 1711
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2631
Mailing Address - Country:US
Mailing Address - Phone:302-381-9073
Mailing Address - Fax:
Practice Address - Street 1:520 NW 165TH ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6343
Practice Address - Country:US
Practice Address - Phone:786-623-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2023-09-14
Deactivation Date:2022-06-08
Deactivation Code:
Reactivation Date:2023-09-14
Provider Licenses
StateLicense IDTaxonomies
FLSA15634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist