Provider Demographics
NPI:1104029412
Name:CONTRERAS, YVONNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 ASPEN RD SW
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-8070
Mailing Address - Country:US
Mailing Address - Phone:915-204-4113
Mailing Address - Fax:
Practice Address - Street 1:5150 ASPEN RD SW
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-8070
Practice Address - Country:US
Practice Address - Phone:575-537-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist