Healthcare Provider Details

I. General information

NPI: 1225947930
Provider Name (Legal Business Name): SHAWN OWEN YANCEY SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19175 3RD ST
ORO GRANDE CA
92368-9507
US

IV. Provider business mailing address

19175 3RD ST
ORO GRANDE CA
92368-9507
US

V. Phone/Fax

Practice location:
  • Phone: 760-780-9842
  • Fax:
Mailing address:
  • Phone: 760-780-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: