Healthcare Provider Details

I. General information

NPI: 1386171478
Provider Name (Legal Business Name): ASHLEY YEAGER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 LORNA SQ
BIRMINGHAM AL
35216-5480
US

IV. Provider business mailing address

2104 ROCKY RIDGE RD
BIRMINGHAM AL
35216-5138
US

V. Phone/Fax

Practice location:
  • Phone: 205-967-0811
  • Fax:
Mailing address:
  • Phone: 205-967-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4021C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: