Provider Demographics
NPI:1003216128
Name:YARBROUGH-MAXWELL, TENAYA LATRICE (MA-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TENAYA
Middle Name:LATRICE
Last Name:YARBROUGH-MAXWELL
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 W OSLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-7368
Mailing Address - Country:US
Mailing Address - Phone:559-761-3813
Mailing Address - Fax:
Practice Address - Street 1:4602 W OSLIN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-7368
Practice Address - Country:US
Practice Address - Phone:559-761-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist