Provider Demographics
NPI:1194260794
Name:CLYDEN, EMILY CLAIRE (MHS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CLAIRE
Last Name:CLYDEN
Suffix:
Gender:F
Credentials:MHS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14005 E STATE ROUTE 114
Mailing Address - Street 2:
Mailing Address - City:MOMENCE
Mailing Address - State:IL
Mailing Address - Zip Code:60954-3789
Mailing Address - Country:US
Mailing Address - Phone:815-953-7884
Mailing Address - Fax:
Practice Address - Street 1:200 EAST COURT STREET
Practice Address - Street 2:SUITE #708
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901
Practice Address - Country:US
Practice Address - Phone:815-409-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14600953Y235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist