Provider Demographics
NPI:1740612316
Name:LYNCH, YASHARA (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:YASHARA
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOUTHPORT RD APT 49
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3866
Mailing Address - Country:US
Mailing Address - Phone:615-839-8670
Mailing Address - Fax:
Practice Address - Street 1:2375 E MAIN ST STE A202
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1400
Practice Address - Country:US
Practice Address - Phone:615-839-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1814Medicaid