Healthcare Provider Details

I. General information

NPI: 1205396348
Provider Name (Legal Business Name): JENNIFER YEAKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 03/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 JANNEY ST
PHILADELPHIA PA
19125-1810
US

IV. Provider business mailing address

2647 JANNEY ST
PHILADELPHIA PA
19125-1810
US

V. Phone/Fax

Practice location:
  • Phone: 267-218-4497
  • Fax:
Mailing address:
  • Phone: 267-218-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW134087
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: