MEDICARE: MS. ELLI EMMANUEL M.A. C.C.C. /S.L.P

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	SA1179	FL
2	104100000X	Social Worker
3	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316043235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLI EMMANUEL M.A. C.C.C. /S.L.P

Provider Business Mailing Address
First Line	:	1440 PARK SHORE CIR
Second Line	:	#1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9614
Country	:	US
Telephone Number	:	239-826-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 PARK SHORE CIR
Second Line	:	#1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9614
Country	:	US
Telephone Number	:	239-826-3593
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/20/2017

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