Provider Demographics
NPI:1063638617
Name:YATES, LUANN B (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:B
Last Name:YATES
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 1:7851 ENON DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-1515
Mailing Address - Country:US
Mailing Address - Phone:540-265-5655
Mailing Address - Fax:540-265-0386
Practice Address - Street 1:7851 ENON DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-1515
Practice Address - Country:US
Practice Address - Phone:540-265-5655
Practice Address - Fax:540-265-0386
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist