Provider Demographics
NPI:1386536142
Name:DZIUBLA, EMILY ROSE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:DZIUBLA
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:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:ASH FORK
Mailing Address - State:AZ
Mailing Address - Zip Code:86320-0576
Mailing Address - Country:US
Mailing Address - Phone:928-640-2267
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 576
Practice Address - Street 2:
Practice Address - City:ASH FORK
Practice Address - State:AZ
Practice Address - Zip Code:86320-0576
Practice Address - Country:US
Practice Address - Phone:928-640-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA163202355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant