Provider Demographics
NPI:1881443224
Name:MIKLUSAK, EMILY ROSE (AUD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:MIKLUSAK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 NORTHPARK DR STE 10
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2215
Mailing Address - Country:US
Mailing Address - Phone:812-372-1886
Mailing Address - Fax:
Practice Address - Street 1:2475 NORTHPARK DR STE 10
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2215
Practice Address - Country:US
Practice Address - Phone:812-372-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist