Provider Demographics
NPI:1760634109
Name:STICCA, YVETTE M (MA)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:M
Last Name:STICCA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:YVETTE
Other - Middle Name:MARIE
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5635 E AVON LIMA RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9575
Mailing Address - Country:US
Mailing Address - Phone:585-226-6046
Mailing Address - Fax:
Practice Address - Street 1:344 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3330
Practice Address - Country:US
Practice Address - Phone:845-562-6220
Practice Address - Fax:845-562-6221
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016370-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016370OtherNEW YORK STATE SPEECH AND LANGUAGE PATHOLOGIST LICENSE