Healthcare Provider Details

I. General information

NPI: 1598471179
Provider Name (Legal Business Name): EMMA-ELISE CARMEN CUNNINGHAM CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 WALLER RD # 200
RICHMOND VA
23230-2912
US

IV. Provider business mailing address

1308 ROSENEATH RD APT 418
RICHMOND VA
23230-4652
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-5010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001069
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: