Healthcare Provider Details

I. General information

NPI: 1174433148
Provider Name (Legal Business Name): AMANDA YEAZEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 7TH ST UNIT D5
WINDSOR CO
80550-6332
US

IV. Provider business mailing address

2035 7TH ST UNIT D5
WINDSOR CO
80550-6332
US

V. Phone/Fax

Practice location:
  • Phone: 970-408-0434
  • Fax:
Mailing address:
  • Phone: 970-408-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933544
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: