Healthcare Provider Details

I. General information

NPI: 1417745944
Provider Name (Legal Business Name): JENNIFER LEE YATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN ST NW STE 1
ELK RIVER MN
55330-1542
US

IV. Provider business mailing address

231 MAIN ST NW STE 1
ELK RIVER MN
55330-1542
US

V. Phone/Fax

Practice location:
  • Phone: 763-438-4971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31683
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: