Provider Demographics
NPI:1720533391
Name:MISCHKE, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MISCHKE
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 1:450 WAIANUENUE AVE RM 4
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2521
Mailing Address - Country:US
Mailing Address - Phone:816-686-6716
Mailing Address - Fax:
Practice Address - Street 1:450 WAIANUENUE AVE RM 4
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2521
Practice Address - Country:US
Practice Address - Phone:816-686-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160305272355S0801X
MO2024033152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22951OtherMEDICARE
HISP-2378Medicaid
MO962180774Medicaid
MO962180774OtherUNITED HEALTH CRARE