Provider Demographics
NPI:1083235147
Name:YARBROUGH, DEREK ANDREW (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ANDREW
Last Name:YARBROUGH
Suffix:
Gender:M
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 N FM 620 RD APT 1024
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4151
Mailing Address - Country:US
Mailing Address - Phone:409-670-2671
Mailing Address - Fax:
Practice Address - Street 1:8225 N FM 620 RD APT 1024
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4151
Practice Address - Country:US
Practice Address - Phone:409-670-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist