Healthcare Provider Details

I. General information

NPI: 1245953447
Provider Name (Legal Business Name): EMILY COKLEY SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLD CHEROKEE RD
LEXINGTON SC
29072-9406
US

IV. Provider business mailing address

720 OLD CHEROKEE RD
LEXINGTON SC
29072-9406
US

V. Phone/Fax

Practice location:
  • Phone: 803-490-0960
  • Fax:
Mailing address:
  • Phone: 803-490-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: