Provider Demographics
NPI:1063726727
Name:EMMI, LUCILLE ANN MARIE
Entity type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:ANN MARIE
Last Name:EMMI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LUCILLE
Other - Middle Name:MARIE
Other - Last Name:SMALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC; NYS LICENSE
Mailing Address - Street 1:4439 MCKINLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1040
Mailing Address - Country:US
Mailing Address - Phone:716-648-3783
Mailing Address - Fax:
Practice Address - Street 1:4439 MCKINLEY PKWY
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1040
Practice Address - Country:US
Practice Address - Phone:716-648-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003153-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist