Healthcare Provider Details

I. General information

NPI: 1205463668
Provider Name (Legal Business Name): ANDREA MARIE YEAGER MPS, LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MARIE KASPER

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 THOMPSON AVE E STE 150
WEST ST PAUL MN
55118-3238
US

IV. Provider business mailing address

4240 PARK GLEN RD
ST LOUIS PARK MN
55416-5427
US

V. Phone/Fax

Practice location:
  • Phone: 651-450-0860
  • Fax: 651-450-0759
Mailing address:
  • Phone: 612-925-6033
  • Fax: 612-925-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305342
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2989
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: