Provider Demographics
NPI:1295344190
Name:NIEBEL, EMILY ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:NIEBEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 CRESTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8002
Mailing Address - Country:US
Mailing Address - Phone:832-257-5553
Mailing Address - Fax:
Practice Address - Street 1:11133 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-5833
Practice Address - Country:US
Practice Address - Phone:936-494-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist