Provider Demographics
NPI:1134729197
Name:STREVENS, YANA (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:STREVENS
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:SERIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH THERAPIST
Mailing Address - Street 1:382 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1379
Mailing Address - Country:US
Mailing Address - Phone:203-250-9663
Mailing Address - Fax:203-699-9641
Practice Address - Street 1:1064 E MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4898
Practice Address - Country:US
Practice Address - Phone:203-440-3750
Practice Address - Fax:203-699-9641
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist