Healthcare Provider Details

I. General information

NPI: 1639505340
Provider Name (Legal Business Name): EMILY ANNE O'ROURKE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11870 PIERCE ST STE 270
RIVERSIDE CA
92505-5186
US

IV. Provider business mailing address

11870 PIERCE ST STE 270
RIVERSIDE CA
92505-5186
US

V. Phone/Fax

Practice location:
  • Phone: 951-808-5850
  • Fax: 951-808-5860
Mailing address:
  • Phone: 951-808-5850
  • Fax: 951-808-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA 2348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: