Healthcare Provider Details

I. General information

NPI: 1871129759
Provider Name (Legal Business Name): EMILY MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE ST
BOSTON MA
02130-3446
US

IV. Provider business mailing address

36 HOLBROOK ST APT 2
BOSTON MA
02130-2756
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-4498
  • Fax:
Mailing address:
  • Phone: 407-408-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number77772
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: