Provider Demographics
NPI:1952891855
Name:KING, EMILY KATHERINE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
Last Name:KING
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 1:2420 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6000
Mailing Address - Country:US
Mailing Address - Phone:812-282-8248
Mailing Address - Fax:812-206-8289
Practice Address - Street 1:2420 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-6000
Practice Address - Country:US
Practice Address - Phone:812-282-8248
Practice Address - Fax:812-206-8289
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker