MEDICARE: MS. JANICE B YEARY MSE, 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	15381	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80T421	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497986392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE B YEARY MSE, CCC, SLP

Provider Business Mailing Address
First Line	:	PO BOX 100722
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-0722
Country	:	US
Telephone Number	:	817-247-0654
Fax Number	:	817-847-0205

Provider Business Practice Location Address
First Line	:	3901 W VICKERY BLVD
Second Line	:	SUITE #1
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5672
Country	:	US
Telephone Number	:	817-247-0654
Fax Number	:	817-847-0205

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	03/08/2012

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