Healthcare Provider Details

I. General information

NPI: 1235680901
Provider Name (Legal Business Name): PAM YEAGER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 BAILEY RD
CUYAHOGA FALLS OH
44221-5211
US

IV. Provider business mailing address

18 N FORGE ST
AKRON OH
44304-1317
US

V. Phone/Fax

Practice location:
  • Phone: 330-928-2042
  • Fax:
Mailing address:
  • Phone: 330-762-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.142484-M-IV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2002131-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: