Provider Demographics
NPI:1063191989
Name:FANE, EMMA JEAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JEAN
Last Name:FANE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ORANGE ST APT 306
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4103
Mailing Address - Country:US
Mailing Address - Phone:510-396-4595
Mailing Address - Fax:
Practice Address - Street 1:233 ORANGE ST APT 306
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4103
Practice Address - Country:US
Practice Address - Phone:510-396-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist