Provider Demographics
NPI:1902097322
Name:YATES, ANDREA J (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:J
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 1:201 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9316
Mailing Address - Country:US
Mailing Address - Phone:479-200-7874
Mailing Address - Fax:
Practice Address - Street 1:201 MONROE ST
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9316
Practice Address - Country:US
Practice Address - Phone:479-200-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist