Provider Demographics
NPI:1891330718
Name:YARUSS, JONATHAN SCOTT (PHD, CCC-SLP, BCS-F)
Entity Type:Individual
Prefix:PROF
First Name:JONATHAN
Middle Name:SCOTT
Last Name:YARUSS
Suffix:
Gender:M
Credentials:PHD, CCC-SLP, BCS-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 RED CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-3405
Mailing Address - Country:US
Mailing Address - Phone:517-884-2406
Mailing Address - Fax:
Practice Address - Street 1:1026 RED CEDAR RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-3405
Practice Address - Country:US
Practice Address - Phone:517-884-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist