Healthcare Provider Details

I. General information

NPI: 1063326692
Provider Name (Legal Business Name): EMILY PAULINE BAKER GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 NW CAPTAIN CT
OAK HARBOR WA
98277-2066
US

IV. Provider business mailing address

188 NW CAPTAIN CT
OAK HARBOR WA
98277-2066
US

V. Phone/Fax

Practice location:
  • Phone: 760-953-9977
  • Fax:
Mailing address:
  • Phone: 760-953-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA.SP.70099679
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: