Healthcare Provider Details

I. General information

NPI: 1659229391
Provider Name (Legal Business Name): MARI YAO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARI UYEMURA CCC-SLP

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 DIAMOND HEIGHTS BLVD APT B
SAN FRANCISCO CA
94131-1890
US

IV. Provider business mailing address

5120 DIAMOND HEIGHTS BLVD APT B
SAN FRANCISCO CA
94131-1890
US

V. Phone/Fax

Practice location:
  • Phone: 415-264-0398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP15323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: