Provider Demographics
NPI:1407104821
Name:YAGUDA, KIYA JOYCE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIYA
Middle Name:JOYCE
Last Name:YAGUDA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KIYA
Other - Middle Name:JOYCE
Other - Last Name:YAGUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:346 HANGING MOSS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6251
Mailing Address - Country:US
Mailing Address - Phone:407-436-8821
Mailing Address - Fax:
Practice Address - Street 1:620 N WYMORE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4268
Practice Address - Country:US
Practice Address - Phone:407-647-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist