Healthcare Provider Details

I. General information

NPI: 1760655401
Provider Name (Legal Business Name): BARBARA YEZIORNA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA WAITE-WRIGHT MSW

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 S BRENTWOOD BLVD
SAINT LOUIS MO
63144-1803
US

IV. Provider business mailing address

2211 S BRENTWOOD BLVD
SAINT LOUIS MO
63144-1803
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-0246
  • Fax:
Mailing address:
  • Phone: 314-394-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2001031176
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: