Provider Demographics
NPI:1962717355
Name:EMERSON, ELIZABETH WALKER (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:WALKER
Last Name:EMERSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-5100
Mailing Address - Country:US
Mailing Address - Phone:207-474-7424
Mailing Address - Fax:207-474-0001
Practice Address - Street 1:199 W FRONT ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-5100
Practice Address - Country:US
Practice Address - Phone:207-474-7424
Practice Address - Fax:207-474-0001
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist