Provider Demographics
NPI:1003047036
Name:RYLAND-LEE, YANIQUE NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:YANIQUE
Middle Name:NICOLE
Last Name:RYLAND-LEE
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 1:10120 NW 4TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3977
Mailing Address - Country:US
Mailing Address - Phone:954-815-4004
Mailing Address - Fax:
Practice Address - Street 1:10120 NW 4TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3977
Practice Address - Country:US
Practice Address - Phone:954-815-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist