Healthcare Provider Details

I. General information

NPI: 1467278853
Provider Name (Legal Business Name): MELISSA LYNN YATES MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 HAZELTINE BLVD STE 476
CHASKA MN
55318-1072
US

IV. Provider business mailing address

1107 HAZELTINE BOULEVARD, STE 476 MD 58
CHASKA MN
55318-1072
US

V. Phone/Fax

Practice location:
  • Phone: 952-479-0824
  • Fax:
Mailing address:
  • Phone: 952-479-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22080
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: