Provider Demographics
NPI:1184868283
Name:YODER-BLACK, DEANNA LEA (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LEA
Last Name:YODER-BLACK
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:LEA
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:1731 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1512
Mailing Address - Country:US
Mailing Address - Phone:715-568-4669
Mailing Address - Fax:
Practice Address - Street 1:401 E BOGARD RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7108
Practice Address - Country:US
Practice Address - Phone:907-357-2578
Practice Address - Fax:907-357-2529
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist