Basic Information
| Provider Information | |||||||||
| NPI: | 1376057547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YETHIPATHI | ||||||||
| FirstName: | SWATHI | ||||||||
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| Credential: | SP2220 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4273 THE MASTERS DR STE A | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945339512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075994744 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 AVENUE H | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2017 | ||||||||
| LastUpdateDate: | 11/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP25244 | CA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP2220 | NV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.