MEDICARE: MRS. YVETTE RENEE WHITE MS,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	22002982A	IN

General Provider Information

NPI Number	:	1003943887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVETTE RENEE WHITE MS,CCC-SLP

Provider Business Mailing Address
First Line	:	3647 BRANCH WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3678
Country	:	US
Telephone Number	:	317-989-2229
Fax Number	:	317-871-2867

Provider Business Practice Location Address
First Line	:	3647 BRANCH WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3678
Country	:	US
Telephone Number	:	317-989-2229
Fax Number	:	317-871-2867

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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