Provider Demographics
NPI:1851556047
Name:YAKUNICH, JUDY (MA,CCC-A)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:YAKUNICH
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15299 BAGLEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4809
Mailing Address - Country:US
Mailing Address - Phone:440-816-5091
Mailing Address - Fax:
Practice Address - Street 1:15299 BAGLEY RD
Practice Address - Street 2:#300
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4823
Practice Address - Country:US
Practice Address - Phone:440-779-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01153231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0972309Medicaid
OH2085550Medicaid
OH2085523Medicaid
OHP00681449OtherMEDICARE RAILROAD PTAN
OHE9250486Medicare PIN
OHE9250481Medicare PIN
OH2085523Medicaid