Provider Demographics
NPI:1154878148
Name:PUKOS, EMILY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PUKOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WALLACE WAY BLDG 9
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6215
Mailing Address - Country:US
Mailing Address - Phone:585-617-2314
Mailing Address - Fax:
Practice Address - Street 1:160 WALLACE WAY BLDG 9
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6215
Practice Address - Country:US
Practice Address - Phone:585-617-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY026859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program