Healthcare Provider Details

I. General information

NPI: 1972161552
Provider Name (Legal Business Name): EMILY SUE SIMMONS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MDG UNIT 3690
APO AE
09126
US

IV. Provider business mailing address

52 MDG UNIT 3690
APO AE
09126
US

V. Phone/Fax

Practice location:
  • Phone: 314-452-8333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: