Healthcare Provider Details

I. General information

NPI: 1407660905
Provider Name (Legal Business Name): VACA VALLEY SPEECH THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HARTFORD AVE
VACAVILLE CA
95687-5729
US

IV. Provider business mailing address

3069 ALAMO DR # 161
VACAVILLE CA
95687-6344
US

V. Phone/Fax

Practice location:
  • Phone: 707-266-4051
  • Fax:
Mailing address:
  • Phone: 707-266-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EMILY SANDAU
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 707-266-4051