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NPI Code Detail

MEDICARE: MRS. EMILY H WYCOFF M.ED.,CCC-SLP

MEDICARE: MRS. EMILY H WYCOFF M.ED.,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
1235Z00000XSpeech-Language Pathologist2202001523VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1195185OTHERVAANTHEM
20007790506OTHERVAAETNA
3240052OTHERVAMAMSI

General Provider Information

NPI Number : 1750467536
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILY H WYCOFF M.ED.,CCC-SLP
Provider Business Mailing Address
First Line : 2030 COLONIAL AVE SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-3204
Country : US
Telephone Number : 540-343-0165
Fax Number : 540-345-4664
Provider Business Practice Location Address
First Line : 2030 COLONIAL AVE SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-3204
Country : US
Telephone Number : 540-343-0165
Fax Number : 540-345-4664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. EMILY H WYCOFF M.ED.,CCC-SLP” Practice Location

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