Healthcare Provider Details

I. General information

NPI: 1023697737
Provider Name (Legal Business Name): EMILY TRICK SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST
GREENVILLE OH
45331-1395
US

IV. Provider business mailing address

1498 N BROADWAY ST
GREENVILLE OH
45331-2454
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-2319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.13997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: