Provider Demographics
NPI:1104449131
Name:MANDERSON, EMILY JANE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JANE
Last Name:MANDERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JANE
Other - Last Name:BORTOLONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:23 SITTERLY RD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5613
Mailing Address - Country:US
Mailing Address - Phone:518-899-9235
Mailing Address - Fax:
Practice Address - Street 1:23 SITTERLY RD
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-5613
Practice Address - Country:US
Practice Address - Phone:518-899-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist