Individual
EMILY DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4870 HAYGOOD RD, VIRGINIA BEACH, VA 23455-5300
(757) 499-1290
Mailing address
4870 HAYGOOD RD STE 102, VIRGINIA BEACH, VA 23455-5300
(757) 499-1290
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202007692
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12097697
ASHA CERTIFICATION CCC-SLP
VA
01
—
2202007692
VIRGINIA LICENSE
VA
Enumeration date
06/20/2017
Last updated
06/20/2017
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