Provider Demographics
NPI:1124489059
Name:KRAFT, EMILY ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HAWKINS AVE
Mailing Address - Street 2:APT 1 LOWER
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4836
Mailing Address - Country:US
Mailing Address - Phone:315-251-4900
Mailing Address - Fax:
Practice Address - Street 1:54 HAWKINS AVE
Practice Address - Street 2:APT 1 LOWER
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4836
Practice Address - Country:US
Practice Address - Phone:315-251-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-20
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0251251235Z00000X
MA76665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist