Healthcare Provider Details

I. General information

NPI: 1457265118
Provider Name (Legal Business Name): DEANNA MOSHER MS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 MEADOWLARK DR
FAIRFIELD CA
94533-2460
US

IV. Provider business mailing address

3840 HOWE ST APT 112 APT. 112
OAKLAND CA
94611-5382
US

V. Phone/Fax

Practice location:
  • Phone: 707-420-2300
  • Fax:
Mailing address:
  • Phone: 320-292-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: