Provider Demographics
NPI:1720583537
Name:YATES, JESSICA GLIDEWELL
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:GLIDEWELL
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12202 PLANTERS ROW CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2270
Mailing Address - Country:US
Mailing Address - Phone:804-839-0344
Mailing Address - Fax:
Practice Address - Street 1:401 CHARTER COLONY PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4366
Practice Address - Country:US
Practice Address - Phone:804-378-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist