Healthcare Provider Details

I. General information

NPI: 1952780660
Provider Name (Legal Business Name): EMILY LINCOLN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HARBOR BEND CT
LAKE ST LOUIS MO
63367-1478
US

IV. Provider business mailing address

8917 WRENWOOD LN
BRENTWOOD MO
63144-1704
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-2080
  • Fax:
Mailing address:
  • Phone: 314-280-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2014024700
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: