1598932857 NPI number — MRS. CHERYL LEE YAKAVONIS NCC, LPC

Table of content: EMILY ANN SCHADT DMD 5/17/15 (NPI 1902292311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598932857 NPI number — MRS. CHERYL LEE YAKAVONIS NCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAKAVONIS
Provider First Name:
CHERYL
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NCC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598932857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 261
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TANNERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18372-0261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-213-2817
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 LEARN RD FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372-7951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-213-2817
Provider Business Practice Location Address Fax Number:
855-244-2286
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC004848 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1033764220001 . This is a "PROMISE PROVIDER ID (CHIP ONLY)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033764220001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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