Basic Information
| Provider Information | |||||||||
| NPI: | 1932870771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANG | ||||||||
| FirstName: | MARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 EUPER LN | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729033232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793006400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5400 EUPER LN | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729033232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793006400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2021 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 201589 | AR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.