Healthcare Provider Details

I. General information

NPI: 1174338537
Provider Name (Legal Business Name): EMILY CIPOLLA DESANTO M.S CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W EDWIN ST
WILLIAMSPORT PA
17701-4909
US

IV. Provider business mailing address

440 JACULIN AVE
SOUTH WILLIAMSPORT PA
17702-7010
US

V. Phone/Fax

Practice location:
  • Phone: 570-979-4952
  • Fax:
Mailing address:
  • Phone: 570-447-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL012394
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: