Provider Demographics
NPI:1396038295
Name:YAGER THERAPY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:YAGER THERAPY ENTERPRISES, INC.
Other - Org Name:S.T.A.R. LEARNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:305-926-1377
Mailing Address - Street 1:11201 SW 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3905
Mailing Address - Country:US
Mailing Address - Phone:305-926-1377
Mailing Address - Fax:786-250-5444
Practice Address - Street 1:11201 SW 108TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3905
Practice Address - Country:US
Practice Address - Phone:305-926-1377
Practice Address - Fax:786-250-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888782900Medicaid