Provider Demographics
NPI:1851873269
Name:REVECHO-VIERNES, YASMIN PERLAS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:PERLAS
Last Name:REVECHO-VIERNES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:REVECHO
Other - Last Name:VIERNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:17058 NE 115TH WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2316
Mailing Address - Country:US
Mailing Address - Phone:425-702-9826
Mailing Address - Fax:
Practice Address - Street 1:17058 NE 115TH WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-2316
Practice Address - Country:US
Practice Address - Phone:425-702-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60501337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL60501337OtherWA STATE LICENSE