MEDICARE: EMILY CHAMPION

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	COND.20222172-SP	OH

General Provider Information

NPI Number	:	1588383764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CHAMPION

Provider Business Mailing Address
First Line	:	4551 LARIMER ST APT 202
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-2974
Country	:	US
Telephone Number	:	616-350-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 HOLT RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-9688
Country	:	US
Telephone Number	:	614-801-8700
Fax Number	:

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

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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Directions to “ EMILY CHAMPION ” Practice Location

Language	Start Address	Practice Location

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