MEDICARE: YVETTE SIERRA DUCHENE M.S., 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	18160	TX

General Provider Information

NPI Number	:	1215178819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE SIERRA DUCHENE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5690 SANTA TERESITA DR STE A-1
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9206
Country	:	US
Telephone Number	:	915-603-5019
Fax Number	:	866-830-3399

Provider Business Practice Location Address
First Line	:	5690 SANTA TERESITA DR STE A-1
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9206
Country	:	US
Telephone Number	:	915-603-5019
Fax Number	:	866-830-3399

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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Directions to “ YVETTE SIERRA DUCHENE M.S., CCC-SLP” Practice Location

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