Provider Demographics
NPI:1316530827
Name:WADDELL, EMILEE M
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:M
Last Name:WADDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12008 W US HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-8363
Mailing Address - Country:US
Mailing Address - Phone:270-763-8225
Mailing Address - Fax:270-763-8125
Practice Address - Street 1:12008 W US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-8363
Practice Address - Country:US
Practice Address - Phone:270-763-8225
Practice Address - Fax:270-763-8125
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician