Provider Demographics
NPI:1699501809
Name:CALLAN, EMILY ANNE (MS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:CALLAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:JEFFCOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-1230
Mailing Address - Country:US
Mailing Address - Phone:864-437-3405
Mailing Address - Fax:
Practice Address - Street 1:1111 EDGEFIELD ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3849
Practice Address - Country:US
Practice Address - Phone:864-554-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist