MEDICARE: MRS. EMOLA CLEMONS

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	2355S0801X	Speech-Language Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295270163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMOLA CLEMONS

Provider Business Mailing Address
First Line	:	1221 W HIGHWAY 49
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-1716
Country	:	US
Telephone Number	:	870-572-1335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W HIGHWAY 49
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-1716
Country	:	US
Telephone Number	:	870-572-1335
Fax Number	:

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

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	12/30/2016

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