Healthcare Provider Details

I. General information

NPI: 1457892713
Provider Name (Legal Business Name): YECKLEY SPEECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2017
Last Update Date: 03/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N 2ND ST
COLTON CA
92324-1760
US

IV. Provider business mailing address

1170 N 2ND ST
COLTON CA
92324-1760
US

V. Phone/Fax

Practice location:
  • Phone: 909-938-2251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSP7217
License Number StateCA

VIII. Authorized Official

Name: REBECCA KING YECKLEY
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 909-938-2251