Provider Demographics
NPI:1013571637
Name:YADAO, SUZANNE ALISON (SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ALISON
Last Name:YADAO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2933
Mailing Address - Country:US
Mailing Address - Phone:916-761-9826
Mailing Address - Fax:
Practice Address - Street 1:4101 LOS COCHES WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5239
Practice Address - Country:US
Practice Address - Phone:916-761-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist