Provider Demographics
NPI:1609911031
Name:YAUCH CADDEN, LISA DIANE (MS CCCSLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:YAUCH CADDEN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:92 GRAPE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2143
Mailing Address - Country:US
Mailing Address - Phone:508-991-2332
Mailing Address - Fax:508-991-8437
Practice Address - Street 1:92 GRAPE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2143
Practice Address - Country:US
Practice Address - Phone:508-991-2332
Practice Address - Fax:508-991-8437
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2851235Z00000X
RI0500235Z00000X
CT003881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-3581104OtherUNITED HEALTH CARE
0720186OtherTRICARE
MA1609911031OtherBMC
04-3581104OtherAETNA
AA147788OtherHARVARD PILGRIM
691582OtherTUFTS
MASP0158OtherBLUE CROSS BLUE SHIELD
MA0720186Medicaid