Healthcare Provider Details

I. General information

NPI: 1396191193
Provider Name (Legal Business Name): EMMA IDDINGS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELAWARE AVE SUITE 101
MARION OH
43302-6475
US

IV. Provider business mailing address

120 BARTLETT ST
DELAWARE OH
43015-5033
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-2513
  • Fax:
Mailing address:
  • Phone: 517-331-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: