Healthcare Provider Details

I. General information

NPI: 1477187854
Provider Name (Legal Business Name): EMILY MIHALOVIC MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LINEBERRY BLVD
MOUNT JULIET TN
37122-5517
US

IV. Provider business mailing address

4807 CONCORD DR
HERMITAGE TN
37076-1506
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4888
  • Fax:
Mailing address:
  • Phone: 608-797-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0000006679
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: