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General NPI Number Information
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NPI Number | 1174974570
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Entity Type | Individual
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Provider Name | STACIE YELDELL M.A,, MT-BC, AVPT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 552 VENICE BLVD
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City | VENICE
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State | CA
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Zip | 90291-4212
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Country | US
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Telephone | 424-230-6335
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Fax |
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Provider Business Mailing Address
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Address Line | 552 VENICE BLVD
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City | VENICE
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State | CA
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Zip | 90291-4212
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Country | US
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Telephone | 424-230-6335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 07920
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License Number State | PA
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