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NPI Code Detail

MEDICARE: LINDA JEANNE MIX YATES SLP

MEDICARE: LINDA JEANNE MIX YATES 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
1224Z00000XOccupational Therapy Assistant201829MN
2235Z00000XSpeech-Language Pathologist528912MN

General Provider Information

NPI Number : 1003250861
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA JEANNE MIX YATES SLP
Provider Business Mailing Address
First Line : 7900 W 28TH ST
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-3011
Country : US
Telephone Number : 952-920-8380
Fax Number : 952-920-8764
Provider Business Practice Location Address
First Line : 6545 FLYING CLOUD DR STE 201
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3356
Country : US
Telephone Number : 612-364-1901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2013
Last Update Date : 07/17/2024

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Directions to “ LINDA JEANNE MIX YATES SLP” Practice Location

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