MEDICARE: DR. SUSAN K YODER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	4568	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104844190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN K YODER PHD

Provider Business Mailing Address
First Line	:	8170 SOUTH AVE
Second Line	:	SUITE 1
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6434
Country	:	US
Telephone Number	:	330-726-2965
Fax Number	:	330-726-0449

Provider Business Practice Location Address
First Line	:	8170 SOUTH AVE
Second Line	:	SUITE 1
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6413
Country	:	US
Telephone Number	:	330-726-2965
Fax Number	:	330-726-0449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/27/2007

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