MEDICARE: EMILY VINCENT MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	15843	CA

General Provider Information

NPI Number	:	1396041778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY VINCENT MS CCC-SLP

Provider Business Mailing Address
First Line	:	230 GRAND AVE STE 201
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-4559
Country	:	US
Telephone Number	:	510-893-8008
Fax Number	:	510-893-8008

Provider Business Practice Location Address
First Line	:	230 GRAND AVE STE 201
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-4559
Country	:	US
Telephone Number	:	510-893-8008
Fax Number	:	510-893-8008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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