Provider Demographics
NPI:1447439542
Name:BUNGER, EMILY BROOKE (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BROOKE
Last Name:BUNGER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HICKORY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8883
Mailing Address - Country:US
Mailing Address - Phone:803-546-7140
Mailing Address - Fax:866-799-7290
Practice Address - Street 1:169 HICKORY MEADOW RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8883
Practice Address - Country:US
Practice Address - Phone:803-546-7140
Practice Address - Fax:866-799-7290
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0823Medicaid