Provider Demographics
NPI:1396050670
Name:YATES, CARRIE N (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:N
Last Name:YATES
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 1:3626 OAK LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1764
Mailing Address - Country:US
Mailing Address - Phone:903-530-2221
Mailing Address - Fax:
Practice Address - Street 1:3626 OAK LEAF CIR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1764
Practice Address - Country:US
Practice Address - Phone:903-530-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist