Basic Information
| Provider Information | |||||||||
| NPI: | 1285290999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBERTS | ||||||||
| FirstName: | EMILIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOURQUE | ||||||||
| OtherFirstName: | EMILIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1289 S LINDEN RD STE A | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102309750 | ||||||||
| FaxNumber: | 8102308799 | ||||||||
| Practice Location | |||||||||
| Address1: | 8273 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484392465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105797184 | ||||||||
| FaxNumber: | 8105797185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2019 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101005842 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.