Provider Demographics
NPI:1689686297
Name:CHAVEZ, YVONNE L (MSSLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:L
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MSSLP-CCC
Other - Prefix:MRS
Other - First Name:YVONNE
Other - Middle Name:LYNN
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSLP-CCC
Mailing Address - Street 1:200 E ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88242-8510
Mailing Address - Country:US
Mailing Address - Phone:505-393-0755
Mailing Address - Fax:505-393-0249
Practice Address - Street 1:200 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88242-8510
Practice Address - Country:US
Practice Address - Phone:505-393-0755
Practice Address - Fax:505-393-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50624253Medicaid