Provider Demographics
NPI:1679037964
Name:SIFUENTES, YARITZMA (SLPA)
Entity Type:Individual
Prefix:
First Name:YARITZMA
Middle Name:
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-4602
Mailing Address - Country:US
Mailing Address - Phone:214-927-3370
Mailing Address - Fax:
Practice Address - Street 1:8150 BROOKRIVER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4068
Practice Address - Country:US
Practice Address - Phone:214-678-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409332355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant