Healthcare Provider Details

I. General information

NPI: 1811557572
Provider Name (Legal Business Name): EMMA KATHRYN EISERT CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

IV. Provider business mailing address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

V. Phone/Fax

Practice location:
  • Phone: 815-434-0857
  • Fax:
Mailing address:
  • Phone: 815-434-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number242005385
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: