Healthcare Provider Details

I. General information

NPI: 1669389276
Provider Name (Legal Business Name): EMMA SOUTHARDS M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 MO-19
SALEM MO
65560
US

IV. Provider business mailing address

206 W SPRUCE ST
HOUSTON MO
65483-1126
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-4607
  • Fax:
Mailing address:
  • Phone: 417-967-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026041135
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: