Provider Demographics
NPI:1821644790
Name:ROMO, YESENIA NOEMI (HAD)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:NOEMI
Last Name:ROMO
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:NIA
Other - Middle Name:
Other - Last Name:ROMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAD
Mailing Address - Street 1:938 N ROUTIERS AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5555
Mailing Address - Country:US
Mailing Address - Phone:317-608-8010
Mailing Address - Fax:
Practice Address - Street 1:2815 E 3RD ST # 1073
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5434
Practice Address - Country:US
Practice Address - Phone:317-608-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001531A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist