Healthcare Provider Details

I. General information

NPI: 1346804549
Provider Name (Legal Business Name): EMMA MCLEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 20TH ST
LEXINGTON MO
64067-1844
US

IV. Provider business mailing address

2108 MAIN ST
LEXINGTON MO
64067-1822
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-4341
  • Fax:
Mailing address:
  • Phone: 816-259-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2019002680
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: