Provider Demographics
NPI:1295111359
Name:SAMALOT- PELLOT, YARLEEN BRISEL (SLP)
Entity type:Individual
Prefix:
First Name:YARLEEN
Middle Name:BRISEL
Last Name:SAMALOT- PELLOT
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 1:6100 PATHFINDER TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1008
Mailing Address - Country:US
Mailing Address - Phone:787-240-5213
Mailing Address - Fax:
Practice Address - Street 1:4305 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4917
Practice Address - Country:US
Practice Address - Phone:817-238-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0026222355S0801X
TX115535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant