Healthcare Provider Details

I. General information

NPI: 1578407086
Provider Name (Legal Business Name): EMILY BROOKE SANDERS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SATURN SKWY
REDDING CA
96002-2813
US

IV. Provider business mailing address

1155 MISTLETOE LN
REDDING CA
96002-0749
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-4130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: