Provider Demographics
NPI:1588489355
Name:HENRY, EMMA DEETTA GREGUIRE (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:DEETTA GREGUIRE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801-809 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4208
Mailing Address - Country:US
Mailing Address - Phone:315-393-4264
Mailing Address - Fax:
Practice Address - Street 1:801-809 PARK STREET
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4208
Practice Address - Country:US
Practice Address - Phone:315-393-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist