Provider Demographics
NPI:1104247667
Name:PAGAN CARRILLO, YAHAIRA ROSE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:ROSE
Last Name:PAGAN CARRILLO
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 1:7000 COOK RD APT 1101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2264
Mailing Address - Country:US
Mailing Address - Phone:787-209-8287
Mailing Address - Fax:
Practice Address - Street 1:7000 COOK RD APT 1101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2264
Practice Address - Country:US
Practice Address - Phone:787-209-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112236235Z00000X
PR2056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist