Basic Information
| Provider Information | |||||||||
| NPI: | 1609264365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YATES | ||||||||
| FirstName: | BIANCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41555 COOK ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922115184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
| FaxNumber: | 7608371013 | ||||||||
| Practice Location | |||||||||
| Address1: | 41555 COOK ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922115184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
| FaxNumber: | 7608371013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2015 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 110237 | TX | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 111575 | TX | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 29724 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.