=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073701330
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMLYN ANN SALAMONE SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 02/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 W. STATE RTE A ARCHIE R-V
-----------------------------------------------------
City | ARCHIE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64725-0106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-293-5312
-----------------------------------------------------
Fax | 816-293-5712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 106
-----------------------------------------------------
City | ARCHIE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64725-0106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-293-5312
-----------------------------------------------------
Fax | 816-293-5712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 110776
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------