Provider Demographics
NPI:1871051805
Name:WALSH, EMILY CLARE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CLARE
Last Name:WALSH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:EMME
Other - Middle Name:CLARE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 66TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5914
Mailing Address - Country:US
Mailing Address - Phone:908-907-8903
Mailing Address - Fax:
Practice Address - Street 1:1201 66TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5914
Practice Address - Country:US
Practice Address - Phone:718-259-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030317OtherSLP LICENSE/REGISTRATION
14340446OtherASHA CCC-SLP