Provider Demographics
NPI:1619392610
Name:YARNEVIC, RUTH
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:YARNEVIC
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 1:1649 BLOSSOM PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4405
Mailing Address - Country:US
Mailing Address - Phone:216-534-0084
Mailing Address - Fax:
Practice Address - Street 1:1649 BLOSSOM PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4405
Practice Address - Country:US
Practice Address - Phone:216-534-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2014108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist