Provider Demographics
NPI:1316505431
Name:YEZIERSKI, AUGUSTA ZENDE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:ZENDE
Last Name:YEZIERSKI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:AUGUSTA
Other - Middle Name:ZENDE
Other - Last Name:REISLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:14544 SAILBOAT CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4372
Mailing Address - Country:US
Mailing Address - Phone:614-657-9921
Mailing Address - Fax:
Practice Address - Street 1:2949 FOX CHASE LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4400
Practice Address - Country:US
Practice Address - Phone:804-430-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000272235Z00000X
VA2202009535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist