Provider Demographics
NPI:1174706352
Name:SHIELDS, EMILY R (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:R
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-9236
Mailing Address - Country:US
Mailing Address - Phone:417-753-2891
Mailing Address - Fax:
Practice Address - Street 1:100 E FRONT ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-9236
Practice Address - Country:US
Practice Address - Phone:417-753-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist