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General NPI Number Information
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NPI Number | 1932610854
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Entity Type | Organization
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Legal Business Name | YO PHILLY KIDS LLC
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 708 S BANCROFT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-2019
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Country | US
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Telephone | 856-495-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 708 S BANCROFT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-2019
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Country | US
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Telephone | 856-495-6581
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | JACLYN G POLAKOFF
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Credential | M.S. CCC-SLP
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Telephone | 856-495-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL011551
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT018012
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License Number State | PA
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