Basic Information
| Provider Information | |||||||||
| NPI: | 1770755407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIKHALCHENKO HARVARD | ||||||||
| FirstName: | YULIA | ||||||||
| MiddleName: | VITALYEVNA | ||||||||
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| OtherLastName: | HARVARD | ||||||||
| OtherFirstName: | YULIA | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12420 ACHE RIDGE LANE | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27703 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12420 ACHE RIDGE LANE | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199337720 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8017 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.