MEDICARE: EMILY JOELLE KVALHEIM MA, CCC-SLP

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	10763	MD

General Provider Information

NPI Number	:	1740818244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JOELLE KVALHEIM MA, CCC-SLP

Provider Business Mailing Address
First Line	:	10910 ROUTE 108
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-0000
Country	:	US
Telephone Number	:	734-277-1368
Fax Number	:

Provider Business Practice Location Address
First Line	:	10910 ROUTE 108
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-0000
Country	:	US
Telephone Number	:	734-277-1368
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	08/31/2023

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