Healthcare Provider Details

I. General information

NPI: 1780508986
Provider Name (Legal Business Name): EMMA MAE CRAIGHEAD (CARLSON)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21005 S SCHOOL RD
PECULIAR MO
64078-9346
US

IV. Provider business mailing address

21005 S SCHOOL RD
PECULIAR MO
64078-9346
US

V. Phone/Fax

Practice location:
  • Phone: 816-892-1300
  • Fax:
Mailing address:
  • Phone: 816-892-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026030961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: