Provider Demographics
NPI:1265028526
Name:YACKO, MALISSA
Entity Type:Individual
Prefix:MS
First Name:MALISSA
Middle Name:
Last Name:YACKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1758
Mailing Address - Country:US
Mailing Address - Phone:330-608-8398
Mailing Address - Fax:
Practice Address - Street 1:602 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1758
Practice Address - Country:US
Practice Address - Phone:330-608-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty