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General NPI Number Information
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NPI Number | 1386338184
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Entity Type | Organization
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Legal Business Name | EMILY PROGRAM P C
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1476 BLAZING STAR BLVD
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City | ALTOONA
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State | WI
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Zip | 54720-2863
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Country | US
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Telephone | 888-364-5977
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Fax |
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Provider Business Mailing Address
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Address Line | 1295 BANDANA BLVD N STE 210
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City | SAINT PAUL
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State | MN
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Zip | 55108-5115
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Country | US
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Telephone | 866-364-5977
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MEREDITH TRUDGEON
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Credential |
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Telephone | 888-364-5977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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