MEDICARE: YARITZMA SIFUENTES SLPA

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	2355S0801X	Speech-Language Assistant	40933	TX

General Provider Information

NPI Number	:	1679037964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YARITZMA SIFUENTES SLPA

Provider Business Mailing Address
First Line	:	207 BRAZOS ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4602
Country	:	US
Telephone Number	:	214-927-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	8150 BROOKRIVER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4068
Country	:	US
Telephone Number	:	214-678-0507
Fax Number	:

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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