Healthcare Provider Details

I. General information

NPI: 1316584295
Provider Name (Legal Business Name): JUDITH ANNE YOAKUM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BRANSON LANDING BLVD STE 408
BRANSON MO
65616-2192
US

IV. Provider business mailing address

525 BRANSON LANDING BLVD STE 408
BRANSON MO
65616-2192
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8313
  • Fax: 417-348-8319
Mailing address:
  • Phone: 417-348-8313
  • Fax: 417-348-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2018035597
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: