Provider Demographics
NPI:1104115013
Name:YARNELL, HEATHER MICKLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICKLE
Last Name:YARNELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 BALUSTRADE BLVD. SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5076
Mailing Address - Country:US
Mailing Address - Phone:334-391-2553
Mailing Address - Fax:
Practice Address - Street 1:5844 BALUSTRADE BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-5076
Practice Address - Country:US
Practice Address - Phone:334-391-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60203329235Z00000X
AL12156111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist