Healthcare Provider Details

I. General information

NPI: 1649634742
Provider Name (Legal Business Name): EMILY ANN HORRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LONGVIEW RD
MISSOURI VALLEY IA
51555-1227
US

IV. Provider business mailing address

3019 N 148TH ST
OMAHA NE
68116-8172
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-2264
  • Fax:
Mailing address:
  • Phone: 402-651-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: