Provider Demographics
NPI:1750029872
Name:DESPAIN, EMILY JOAN (CF-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOAN
Last Name:DESPAIN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 FOUNTAINVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3401
Mailing Address - Country:US
Mailing Address - Phone:815-993-0175
Mailing Address - Fax:
Practice Address - Street 1:3501 DUNN RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6784
Practice Address - Country:US
Practice Address - Phone:314-972-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist