Healthcare Provider Details

I. General information

NPI: 1942269410
Provider Name (Legal Business Name): DANITA YETTER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31MGD/SGOR UNIT 6180 BOX 245
APO AE
09604-0245
IT

IV. Provider business mailing address

PSC 54 BOX 1762
APO AE
09601
US

V. Phone/Fax

Practice location:
  • Phone: 011390434305459
  • Fax:
Mailing address:
  • Phone: 0110434305459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1915
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: