Provider Demographics
NPI:1508011438
Name:AVERSANO, YVETTE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:YVETTE
Middle Name:
Last Name:AVERSANO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SOFIA CT
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589
Mailing Address - Country:US
Mailing Address - Phone:845-787-4145
Mailing Address - Fax:
Practice Address - Street 1:23 SOFIA CT
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589
Practice Address - Country:US
Practice Address - Phone:845-787-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist