Provider Demographics
NPI:1871180992
Name:GREEN, YVETTE MARIE X
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARIE
Last Name:GREEN
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12406
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-0006
Mailing Address - Country:US
Mailing Address - Phone:419-215-2621
Mailing Address - Fax:
Practice Address - Street 1:2542 BEAUFORT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4802
Practice Address - Country:US
Practice Address - Phone:419-215-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251C00000XAgenciesDay Training, Developmentally Disabled Services