Healthcare Provider Details

I. General information

NPI: 1154225852
Provider Name (Legal Business Name): EMMA WELLS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 OLD US 27, SUITE A
ST. JOHNS MI
48879-2423
US

IV. Provider business mailing address

11219 LOWELL RD
DEWITT MI
48820-9159
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-6831
  • Fax:
Mailing address:
  • Phone: 989-243-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009923
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: