Provider Demographics
NPI:1528648755
Name:KUZILLA, EMILY ROSE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:KUZILLA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EATON RIDGE DR APT 309
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-4507
Mailing Address - Country:US
Mailing Address - Phone:440-384-9044
Mailing Address - Fax:
Practice Address - Street 1:420 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2039
Practice Address - Country:US
Practice Address - Phone:330-945-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2019987-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOND.2019987-SPMedicaid