Provider Demographics
NPI:1093324402
Name:AYALA, YARITZA (MS CCC-SLP TSSLD-BE)
Entity Type:Individual
Prefix:MS
First Name:YARITZA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALPHA PL APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3966
Mailing Address - Country:US
Mailing Address - Phone:914-563-1013
Mailing Address - Fax:
Practice Address - Street 1:100 W BOSTON POST RD
Practice Address - Street 2:STUDENT SUPPORT OFFICE
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-220-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP106162235Z00000X
NY031206-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1609159391Medicaid