Provider Demographics
NPI:1255408829
Name:PAGE, YVONNE DE LA FUENTE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:DE LA FUENTE
Last Name:PAGE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 STEEPLE CRSE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1607
Mailing Address - Country:US
Mailing Address - Phone:210-687-1459
Mailing Address - Fax:210-614-8620
Practice Address - Street 1:7434 LOUIS PASTEUR DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4539
Practice Address - Country:US
Practice Address - Phone:210-614-8620
Practice Address - Fax:210-614-8621
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87378TOtherBLUECROSSBLUESHIELD OF TE