Healthcare Provider Details

I. General information

NPI: 1871879601
Provider Name (Legal Business Name): MS. JANET R YEATS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 RAMSEY ST #206
SAINT PAUL MN
55102-2323
US

IV. Provider business mailing address

311 RAMSEY ST #206
SAINT PAUL MN
55102-2323
US

V. Phone/Fax

Practice location:
  • Phone: 651-336-6217
  • Fax: 651-291-8018
Mailing address:
  • Phone: 651-336-6217
  • Fax: 651-291-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1733
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: