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NPI Code Detail

MEDICARE: EMILY PUKOS M.A., CCC-SLP

MEDICARE: EMILY PUKOS M.A., 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
1390200000XStudent in an Organized Health Care Education/Training Program
2235Z00000XSpeech-Language Pathologist026859NY

General Provider Information

NPI Number : 1154878148
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY PUKOS M.A., CCC-SLP
Provider Business Mailing Address
First Line : 160 WALLACE WAY BLDG 9
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-6215
Country : US
Telephone Number : 585-617-2314
Fax Number :
Provider Business Practice Location Address
First Line : 160 WALLACE WAY BLDG 9
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-6215
Country : US
Telephone Number : 585-617-2314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2016
Last Update Date : 01/04/2021

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Directions to “ EMILY PUKOS M.A., CCC-SLP” Practice Location

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