MEDICARE: MRS. LEAH M YAZMER CCLS

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	174400000X	Specialist		CT

General Provider Information

NPI Number	:	1013870021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH M YAZMER CCLS

Provider Business Mailing Address
First Line	:	164 PRINCESS DRIVE, MADISON CT
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443
Country	:	US
Telephone Number	:	860-674-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 PRINCESS DRIVE, MADISON CT
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443
Country	:	US
Telephone Number	:	860-674-0000
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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