Basic Information
| Provider Information | |||||||||
| NPI: | 1366825051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUCOM | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 LEGACY DR | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750345987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669307088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 W WINDCREST ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786244408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309977422 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 06/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 110049 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.