MEDICARE: JANIE EMORY MS. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	30004753	NC

General Provider Information

NPI Number	:	1063351120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIE EMORY MS. CCC-SLP

Provider Business Mailing Address
First Line	:	109 WILLOW TRACE CIR APT 3
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 WILLOW TRACE CIR APT 3
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8809
Country	:	US
Telephone Number	:	704-641-4103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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