Healthcare Provider Details

I. General information

NPI: 1093547499
Provider Name (Legal Business Name): EMERALD VACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 GRAND AVE
GRAND JUNCTION CO
81501-8007
US

IV. Provider business mailing address

2115 GRAND AVE
GRAND JUNCTION CO
81501-8007
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-4872
  • Fax:
Mailing address:
  • Phone: 970-254-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number24464782
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: