Provider Demographics
NPI:1205132727
Name:YORMARK, RAIZY
Entity type:Individual
Prefix:MRS
First Name:RAIZY
Middle Name:
Last Name:YORMARK
Suffix:
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 1:2616 S TWYCKENHAM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1440
Mailing Address - Country:US
Mailing Address - Phone:574-350-3943
Mailing Address - Fax:
Practice Address - Street 1:2716 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-1831
Practice Address - Country:US
Practice Address - Phone:574-350-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker