Provider Demographics
NPI:1417693250
Name:YANCEY, CLARISSA (MS)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:YANCEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 S GOEBBERT RD APT 1060
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5134
Mailing Address - Country:US
Mailing Address - Phone:505-239-6554
Mailing Address - Fax:
Practice Address - Street 1:2901 JUAN TABO BLVD NE STE 100A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1886
Practice Address - Country:US
Practice Address - Phone:505-804-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist