Healthcare Provider Details

I. General information

NPI: 1033434816
Provider Name (Legal Business Name): DONN YODER MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 ILLINOIS ST
PLYMOUTH IN
46563-3622
US

IV. Provider business mailing address

850 N HARRISON ST ATTN: ANNE LAWSON
WARSAW IN
46580-3163
US

V. Phone/Fax

Practice location:
  • Phone: 574-936-9646
  • Fax: 574-935-4773
Mailing address:
  • Phone: 574-267-7878
  • Fax: 574-269-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006650A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: