MEDICARE: MRS. YVONNE DE LA FUENTE PAGE 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	13574	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87378T	OTHER	TX	BLUECROSSBLUESHIELD OF TE

General Provider Information

NPI Number	:	1255408829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE DE LA FUENTE PAGE CCC-SLP

Provider Business Mailing Address
First Line	:	7318 STEEPLE CRSE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1607
Country	:	US
Telephone Number	:	210-687-1459
Fax Number	:	210-614-8620

Provider Business Practice Location Address
First Line	:	7434 LOUIS PASTEUR DR STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4539
Country	:	US
Telephone Number	:	210-614-8620
Fax Number	:	210-614-8621

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. YVONNE DE LA FUENTE PAGE CCC-SLP” Practice Location

Language	Start Address	Practice Location

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