Healthcare Provider Details

I. General information

NPI: 1639414972
Provider Name (Legal Business Name): LORI KRISTEN YAUCH M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16106 WORLINGTON PL
ODESSA FL
33556-5702
US

IV. Provider business mailing address

16106 WORLINGTON PL
ODESSA FL
33556-5702
US

V. Phone/Fax

Practice location:
  • Phone: 813-389-2155
  • Fax:
Mailing address:
  • Phone: 813-389-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: