Provider Demographics
NPI:1861163362
Name:RAINEY, EMMA ALYSE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ALYSE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ALYSE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7347 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3924
Mailing Address - Country:US
Mailing Address - Phone:609-742-7880
Mailing Address - Fax:
Practice Address - Street 1:7347 DRIFTWOOD LN
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3924
Practice Address - Country:US
Practice Address - Phone:609-742-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41S00961000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty