MEDICARE: EMILY MARIE CORLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	SLP.0003355	CO

General Provider Information

NPI Number	:	1285159392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MARIE CORLEY

Provider Business Mailing Address
First Line	:	9208 GRAND CORDERA PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7022
Country	:	US
Telephone Number	:	719-522-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9208 GRAND CORDERA PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7022
Country	:	US
Telephone Number	:	719-522-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	02/26/2021

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Directions to “ EMILY MARIE CORLEY ” Practice Location

Language	Start Address	Practice Location

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