=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720414428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. EMILY LAURA WORDEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2013
-----------------------------------------------------
Last Update Date | 09/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16783 IVES STREET EXT
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-788-5377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 575
-----------------------------------------------------
City | ADAMS CENTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13606-0575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-486-8303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235500000X
-----------------------------------------------------
Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------