MEDICARE: MRS. JUANITA YUILLE 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	R#15-027	AR

General Provider Information

NPI Number	:	1962866731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUANITA YUILLE SLPA

Provider Business Mailing Address
First Line	:	1122 S CROSS ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-4738
Country	:	US
Telephone Number	:	501-343-5934
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 S CROSS ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-4738
Country	:	US
Telephone Number	:	501-343-5934
Fax Number	:

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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