Provider Demographics
NPI:1689357972
Name:STARK, YOCELYNG PATRICIA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:YOCELYNG
Middle Name:PATRICIA
Last Name:STARK
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1739
Mailing Address - Country:US
Mailing Address - Phone:714-876-5700
Mailing Address - Fax:
Practice Address - Street 1:3591 N MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1452
Practice Address - Country:US
Practice Address - Phone:217-362-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist