MEDICARE: YELINA KIM CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL012198	PA

General Provider Information

NPI Number	:	1003213653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELINA KIM CCC-SLP

Provider Business Mailing Address
First Line	:	234 SAINT MARYS ST
Second Line	:
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-3235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 SAINT MARYS ST
Second Line	:
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-3235
Country	:	US
Telephone Number	:	724-674-5038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/25/2014

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Directions to “ YELINA KIM CCC-SLP” Practice Location

Language	Start Address	Practice Location

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