Healthcare Provider Details

I. General information

NPI: 1659656585
Provider Name (Legal Business Name): ANDREA YEAGER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008B BERKMAR DR
CHARLOTTESVILLE VA
22901-1443
US

IV. Provider business mailing address

102 HANEY RD
RUCKERSVILLE VA
22968-2806
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-5031
  • Fax:
Mailing address:
  • Phone: 434-249-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202003651
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: