MEDICARE: MS. DAX YATES SLPA

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	2355S0801X	Speech-Language Assistant	42782	TX

General Provider Information

NPI Number	:	1528775434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAX YATES SLPA

Provider Business Mailing Address
First Line	:	13084 ALEX CHACON
Second Line	:
City	:	SAN ELIZARIO
State	:	TX
Zip	:	79849-7398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 N MESA ST STE F4
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6187
Country	:	US
Telephone Number	:	915-704-1094
Fax Number	:

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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