Healthcare Provider Details

I. General information

NPI: 1497045660
Provider Name (Legal Business Name): SHIRA H YABLOK MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8018 STANFORD AVE
SAINT LOUIS MO
63130-3614
US

IV. Provider business mailing address

8018 STANFORD AVE
SAINT LOUIS MO
63130-3614
US

V. Phone/Fax

Practice location:
  • Phone: 314-256-9043
  • Fax:
Mailing address:
  • Phone: 314-256-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2008013274
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: