Provider Demographics
NPI:1053893941
Name:BRICKEY, EMILY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRICKEY
Suffix:
Gender:F
Credentials:MA 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:PO BOX 9383
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-9383
Mailing Address - Country:US
Mailing Address - Phone:713-459-5422
Mailing Address - Fax:
Practice Address - Street 1:1020 N COUNTY RD W
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-3436
Practice Address - Country:US
Practice Address - Phone:432-332-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist