Healthcare Provider Details

I. General information

NPI: 1023949526
Provider Name (Legal Business Name): EMILY FARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 YOSEMITE AVE
ESCALON CA
95320-1796
US

IV. Provider business mailing address

1330 DENT ST
ESCALON CA
95320-1810
US

V. Phone/Fax

Practice location:
  • Phone: 209-838-3591
  • Fax:
Mailing address:
  • Phone: 209-380-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP31741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: