Healthcare Provider Details

I. General information

NPI: 1871634576
Provider Name (Legal Business Name): JENNIFER DOBSON YEAGLE M.ED., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST # 6011
BALTIMORE MD
21205-2000
US

IV. Provider business mailing address

601 N CAROLINE ST # 6011
BALTIMORE MD
21205-2000
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9259
  • Fax: 410-614-9167
Mailing address:
  • Phone: 410-955-9259
  • Fax: 410-614-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00921
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: