Provider Demographics
NPI:1710043401
Name:YARECK, SAMUEL III (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:YARECK
Suffix:III
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 SADDLECLUB DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2759
Mailing Address - Country:US
Mailing Address - Phone:724-942-3169
Mailing Address - Fax:
Practice Address - Street 1:2 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1407
Practice Address - Country:US
Practice Address - Phone:724-489-9565
Practice Address - Fax:724-489-9566
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02201237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist