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General NPI Number Information
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NPI Number | 1285221101
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Entity Type | Individual
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Provider Name | DESIREE CONTRERAS-PROVOST SLP
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Gender | Female
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Dates
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Enumeration Date | 12/26/2020
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 2910 MCCLURE ST
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City | OAKLAND
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State | CA
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Zip | 94609-3505
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Country | US
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Telephone | 510-836-3677
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Fax |
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Provider Business Mailing Address
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Address Line | 8243 APPLE COVE CT
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City | SACRAMENTO
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State | CA
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Zip | 95828-5711
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Country | US
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Telephone | 916-897-0549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 32962
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License Number State | CA
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