Healthcare Provider Details

I. General information

NPI: 1407782337
Provider Name (Legal Business Name): ISABELLA MARIE FANUCCI FONTANA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 FARMERS LN STE 23
SANTA ROSA CA
95405-6718
US

IV. Provider business mailing address

795 FARMERS LN STE 23
SANTA ROSA CA
95405-6718
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-1468
  • Fax: 707-575-0823
Mailing address:
  • Phone: 707-575-1468
  • Fax: 707-575-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP40155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: