Healthcare Provider Details

I. General information

NPI: 1104947274
Provider Name (Legal Business Name): EMILY TYSON STUDEBAKER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY E TYSON MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 KURTZ DR. KURTZ ELEMENTARY SCHOOL
MILFORD MI
48381
US

IV. Provider business mailing address

2368 S MILFORD RD
HIGHLAND MI
48357
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-8025
  • Fax: 248-684-8024
Mailing address:
  • Phone: 248-648-8000
  • Fax: 248-684-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008025
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: