Provider Demographics
NPI:1487794061
Name:MCCOY, YVETTE M
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:M
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25480 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3801
Mailing Address - Country:US
Mailing Address - Phone:301-769-6456
Mailing Address - Fax:301-302-0129
Practice Address - Street 1:25480 POINT LOOKOUT RD STE 103
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3801
Practice Address - Country:US
Practice Address - Phone:301-672-2148
Practice Address - Fax:301-302-0129
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD05168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist