Provider Demographics
NPI:1548470537
Name:EMERICK, RAE (SLP)
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:EMERICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W GRACE ST APT 318
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4044
Mailing Address - Country:US
Mailing Address - Phone:765-749-2002
Mailing Address - Fax:
Practice Address - Street 1:2350 TAFT STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407
Practice Address - Country:US
Practice Address - Phone:219-977-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist