Provider Demographics
NPI:1700409398
Name:LERVOLD, EMMA (SLPA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:LERVOLD
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:LERVOLD
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3613 LA JOLLA CT APT A
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 SUMMERS LN
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-6600
Practice Address - Country:US
Practice Address - Phone:541-883-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant