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General NPI Number Information
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NPI Number | 1942750971
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Entity Type | Individual
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Provider Name | TESS EMILY TAVILL M.S., CFY-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 2521 STOCKTON BLVD SUITE 6201
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City | SACRAMENTO
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State | CA
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Zip | 95817-2207
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Country | US
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Telephone | 916-734-5158
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Fax |
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Provider Business Mailing Address
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Address Line | 121 51ST ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-2303
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Country | US
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Telephone | 916-548-5103
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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 | 10876
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License Number State | CA
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