Healthcare Provider Details

I. General information

NPI: 1871333591
Provider Name (Legal Business Name): EMILY VIRNIG MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 ROOSEVELT RD
SAINT CLOUD MN
56301-6411
US

IV. Provider business mailing address

2904 ROOSEVELT RD
SAINT CLOUD MN
56301-6411
US

V. Phone/Fax

Practice location:
  • Phone: 320-558-8315
  • Fax:
Mailing address:
  • Phone: 320-558-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: