Healthcare Provider Details

I. General information

NPI: 1437717063
Provider Name (Legal Business Name): JENNIFER FAY SHOWALTER YEOMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax: 907-260-4063
Mailing address:
  • Phone: 907-714-4521
  • Fax: 907-260-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSWS708
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: