Healthcare Provider Details

I. General information

NPI: 1194277640
Provider Name (Legal Business Name): JEANIE YALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N G ST
ABERDEEN WA
98520-5297
US

IV. Provider business mailing address

216 N G ST
ABERDEEN WA
98520-5228
US

V. Phone/Fax

Practice location:
  • Phone: 360-538-2000
  • Fax:
Mailing address:
  • Phone: 360-538-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: