Provider Demographics
NPI:1558762294
Name:YACKS, JUDITH (SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:YACKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1943
Mailing Address - Country:US
Mailing Address - Phone:513-943-3813
Mailing Address - Fax:513-943-3642
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1943
Practice Address - Country:US
Practice Address - Phone:513-943-3813
Practice Address - Fax:513-943-3642
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP1048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist