Basic Information
| Provider Information | |||||||||
| NPI: | 1922745199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDSTROM | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1826 ENSLOW BLVD | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257014910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046631112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1015 OAKHURST DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253142049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043458101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2022 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP-2292 | WV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.