Doctor Name: | MRS. KIMBERLY KAY YEAGLE |
NPI Number: | 1164408936 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, LCSW |
License Number: | 004461 |
Business Practice Address: | 620 E Monroe St Mexico, MO - 652652919 |
Business Phone Number: | 5735828406 |
Business Fax Number: | 5735823706 |
Mailing Address: | 1902 Osage Dr, COLUMBIA |
State: | MO |
Postal Code: | 652025476 |
Phone Number: | 5734742984 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 004461 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |