Healthcare Provider Details

I. General information

NPI: 1174671630
Provider Name (Legal Business Name): JAMES FRANCIS YEAGER EDD., LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W COLLEGE ST
DULUTH MN
55811-4906
US

IV. Provider business mailing address

134 PARKLAND AVE
DULUTH MN
55805-1534
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-8815
  • Fax: 218-724-0251
Mailing address:
  • Phone: 218-724-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07723
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: