Provider Demographics
NPI:1396041778
Name:VINCENT, EMILY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4559
Mailing Address - Country:US
Mailing Address - Phone:510-893-8008
Mailing Address - Fax:510-893-8008
Practice Address - Street 1:230 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4559
Practice Address - Country:US
Practice Address - Phone:510-893-8008
Practice Address - Fax:510-893-8008
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist